Top 30 Most Cited Articles on Festoons, Malar Mounds, Malar Bags, and Malar Edema: A Bibliometric Analysis

BACKGROUND: Festoons, malar mounds, malar bags, and malar edema are recognized sources of patient dissatisfaction after lower-eyelid and midface rejuvenation. Unfortunately, they remain treatment-resistant in periorbital aesthetics. No study has fully characterized the literature guiding the diagnosis and management of these conditions. This study identifies the 30 most-cited articles on this clinical finding. We employed citation frequency as a proxy for scholarly impact to highlight the field's most influential work and identify lacking information. METHODS: A Web of Science Core Collection search using terms for the target entities yielded 1241 records, sorted by Times Cited in descending order. Two reviewers independently screened records against prespecified criteria, with disagreements resolved by reconciliation. The top 30 were retained as the final list. Each article was assigned a topic category, study design, level of evidence, and anatomic subfocus. RESULTS: Thirty included articles were cited a combined 1066 times. Three citations were sufficient for entry to this list. Surgical correction was the most represented topic category (n=12). This was followed by injectable/sclerotherapy and anatomy/pathophysiology (n=6 each). Case series (n=10) and narrative reviews (n=5) were the most common. No article met Oxford Level I or II evidence; 60% were level IV, 37% level V, and 3% level III. CONCLUSIONS: Current literature on festoons, malar mounds, malar bags, and malar edema is dominated by low-level evidence. Citation threshold for entry to its most influential work is correspondingly low. Comparative study remains challenging due to the absence of standardized terminology and a validated severity scale.