Festoon formation after infraorbital botulinum A toxin: A case report

BACKGROUND. An injection of the lateral canthus and infraorbital fold is commonly used to soften wrinkles and widen the eye. OBJECTIVE. To illustrate a case report of festooning and to hypothesize as to its cause. METHODS A 56-year-old man developed festooning of the infraocular area after injection of botulinum toxin A. RESULTS. Prior lower lid blepharoplasty with separation of the infraorbital orbicularis oculi muscle may have weakened the muscle enough to cause festooning with further weakening of the muscle through botulinum toxin A injection. CONCLUSION. Caution must be exercised when performing infraocular injection of botulinum toxin A in patients with prior transtarsal lower lid blepharoplasty.