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Background Many techniques have been presented for the treatment of lower eyelid festoons, but no singular technique has become dominant. Objectives The authors describe the safety and efficacy of intralesional tetracycline injection, the pinch technique, and canthopexy for the treatment of severe festoons. Methods Institutional board review approval was obtained, and a retrospective chart review was performed on 15 consecutive patients who had received 2% tetracycline injections to treat lower eyelid large festoons between February 2017 and February 2020. Three months after the last injection, a series of patients underwent the surgical procedure: pinch technique and canthopexy bilaterally. Results Clinical and photographic records were reviewed, and 12 patients were included in the analysis. Three patients did not return for follow-up after the injection series. Of the 12 patients, there were 3 male patients and 9 female patients, with an average age of 66.6 years. The mean volume injected in each festoon was 0.43 mL, and the mean follow-up was 313 days. A series of injections with a 3-month time interval were performed for patients with a partial response to the initial injection. There was no evidence of complications at the site of the injection. Three months after the last injection, these 12 patients underwent complementary surgical treatment, which included pinch resection and canthopexy. Conclusions These preliminary results suggest that intralesional injections of tetracycline 2% may offer a safe option to treat lower eyelid festoons. This noninvasive procedure represents adjunct benefits to complementary surgical therapy. Level of Evidence: 4

Intralesional Tetracycline Injection, Pinch Technique, and Canthopexy for the Treatment of Severe Festoons: Preliminary Results