Secondary Logo

Journal Logo

Evaluation and Timing of Improvement Following Direct Doxycycline Hyclate Injections for Malar Edema and Lower Eyelid Festoons

Godfrey, Kyle J. MD; Kally, Peter D. MD; Tooley, Andrea A. MD; Freund, Robert MD; Lisman, Richard D. MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 10-11
doi: 10.1097/01.GOX.0000584248.76886.71
Aesthetic Abstracts

Weill Cornell Medical College, New York, NY

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: Tetracycline family antibiotics have demonstrated utility as sclerosing agents for lymphatic malformations and other lesions of impaired fluid drainage, including conjunctival chemosis, eyelid festoons, and malar edema.1–5 However, the timing of improvement and patient-reported subjective outcomes for esthetic use of doxycycline hyclate injections in treating lower eyelid festoons and malar edema is not well-reported. The purpose of this study was to evaluate subjective patient satisfaction and timing of improvement of cosmetically significant lower eyelid festoons and malar edema treated with direct, intralesional injections of doxycycline hyclate.

METHODS: An Institutional Review Board–approved, retrospective review was performed. Inclusion criteria were patients with lower eyelid festoons and/or malar edema treated with direct, intralesional injection of doxycycline hyclate at a concentration of 10 mg/ml. Exclusion criteria were inadequate follow-up, alternate doxycycline concentration, or alternate intervention during the observation period. The primary outcome measure was patient self-reported improvement which was graded as percentage improvement at each visit. Additional data collected included injection volume, concentration, timing of repeat injections, and any subjective patient-reported complaints. Standard statistical calculations were performed.

RESULTS: Twenty-seven treatment areas of 15 patients met inclusion criteria. Average length of final follow-up was 20 weeks (SD, 16 weeks; range, 4–56 weeks). Overall, 9 out of 15 patients subjectively reported complete resolution of their lower eyelid festoons or malar edema and 13 out of 15 patients reported improvement of ≥50%. The average final patient-reported subjective improvement was 80% (SD, 27%; range, 33%–100%). The average time to final subjective improvement in appearance was 16 weeks from initial injection (SD, 10 weeks; range, 4–44). The average number of injections performed per side was 1.4 (SD, 0.64 injections; range, 1–3 injections). When necessary, repeat injections were performed at an average of 16 weeks following prior injection (SD, 3 weeks; range, 12–20 weeks). Average initial injection volume was 0.64 ml (SD, 0.29 ml; range, 0.2–1). Average repeat injection volume was 0.54 ml (SD, 0.35 ml; range, 0.2–1.5 ml). Patient-reported complaints included burning sensation and pain at the time of injection, and transient bruising, edema, and erythema following the injection. No significant dermatologic or visual complications were reported during the documented follow-up period.

CONCLUSIONS: Direct, intralesional injection of doxycycline hyclate at a concentration of 10 mg/ml subjectively improved the appearance of lower eyelid festoons and malar edema. On average, final improvement took approximately 16 weeks.


1. Burrows P, Mitri RK, Alomari A, et al. Percutaneous sclerotherapy of lymphatic malformations with doxycycline. Lymphat Res Biol. 2008;6:209–216.

2. Moesen I, Mombaerts I. Subconjunctival injection of tetracycline 2% for chronic bulbar chemosis after transcutaneous four-eyelid blepharoplasty. Ophthal Plast Reconstr Surg. 2008;24:219–220.

3. Bansal A, Bhatia N, Singh A, et al. Doxycycline sclerodesis as a treatment option for persistent Morel-Lavallee lesions. Injury. 2013;44:66–69.

4. Perry J, Mehta VJ, Costin BR. Intralesional tetracycline injection for treatment of lower eyelid festoons: a preliminary report. Ophthal Plast Reconstr Surg. 2015;31:50–52.

5. Kpodzo D, Nahai F, McCord CD. Malar mounds and festoons: review of current management. Aesthetic Surg J. 2014;34:235–248.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.