Festoons and malar bags - definition and treatment

Key Information

PRICE

Call for more info

TIME OF PROCEDURE

2 hours

DOWNTIME

2-3 weeks

DISCOMFORT LEVEL

2 out of 5

AVERAGE SESSION REQUIRED

Not applicable

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What Are Festoons and Malar Bags?

Festoons and malar bags are two conditions that result in swelling and puffiness around the lower eyelid and cheek area. These issues are often caused by ageing, sun damage, genetics, or weakened facial muscles. They can worsen over time, leading to a permanently tired and swollen appearance.

What Are Malar Bags?

Malar bags are noticeable bulges or mounds on the cheekbones below the lower eyelids. Unlike typical under-eye puffiness, which appears directly beneath the eyes, malar bags are higher up on the face, near the top of the cheeks. These bags can cause the face to appear swollen or tired, disrupting the natural contours of the midface. Malar bags are a cosmetic concern and may signal underlying skin and tissue changes that affect overall facial aesthetics.

What Causes Malar Bags?

Malar bags can also be caused by ageing and genetics. As the facial muscles weaken over time and the skin loses its elasticity, fluid tends to accumulate in the tissues around the cheekbones, forming malar bags.

Over time, the loosening of this muscle and surrounding tissues causes sagging and swelling, often worsened by fluid retention (oedema). Many patients notice malar bags are more prominent in the morning but reduce later in the day. In more severe cases, they can form festoons—folds of skin and tissue beneath the eyes.

Other contributing factors include sun damage, which can break down collagen, and lifestyle choices such as smoking, dehydration, or lack of sleep.

What Are Festoons?

Festoons are a more severe variant of malar bags. They are characterised by sagging areas of skin or puffiness that form beneath the lower eyelids. They are often caused by fluid accumulation, weakened facial muscles, or ageing. Festoons are more pronounced than usual under-eye bags and consist of drapes of skin and tissue which can hang down over the upper cheek, creating a swollen, tired appearance.

Festoons are challenging to treat without expert intervention and tend to worsen over time if left untreated. Effective treatments at The Ezra Clinic target the underlying causes, offering solutions such as laser therapy, fillers, and surgical options for long-lasting results.

What Causes Festoons?

Festoons can be triggered by ageing and genetics. As we age, the skin loses elasticity, and facial muscles weaken, causing the tissue under the eyes to sag and retain fluid. Sun damage, smoking, and dehydration can accelerate the formation of festoons by further weakening the skin.

In some cases, allergies or chronic sinus issues may contribute to fluid buildup, making the puffiness more pronounced. Understanding these causes helps tailor effective treatments for long-lasting results.

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What To Expect From Under Eye Bags Treatment?

The Ezra Clinic offers a personalised approach to treating malar bags and festoons. Our specialists will assess your condition during your initial consultation and recommend the most appropriate treatment.

Options include noninvasive treatments such as laser therapy and surgical procedures such as blepharoplasty or direct festoon excision. The chosen method will depend on the severity of your condition, the underlying causes, and the desired results. Regardless of the treatment, we aim to ensure you achieve natural-looking, long-lasting improvements.

Before the procedure

It’s essential to have a thorough consultation before undergoing treatment for malar bags or festoons. At The Ezra Clinic, our experts will evaluate the severity of your condition and discuss your goals.

During the consultation, we will review your medical history and assess the structure of your face to determine the best approach. Whether you opt for a non-surgical solution or a more comprehensive procedure, we will ensure you are well-informed and comfortable with your treatment plan.

What our patients say

“Prof Ezra and his team provided exceptional care and professionalism throughout my surgery, inspiring confidence and making the experience highly positive.”

– Ann l

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During Under Eye Bags Treatment

Non-surgical options like Endolift laser therapy help tighten skin and reduce puffiness. In more severe cases, surgical interventions like blepharoplasty and midface lifting are recommended to restore the face’s natural contours. Each treatment at The Ezra Clinic is designed to provide long-lasting, natural-looking results while addressing both aesthetic and structural concerns.

Endolift Laser

Endolift Laser is a minimally invasive procedure used to treat under-eye bags, malar bags, and festoons by tightening the skin and reducing excess fat. The procedure is performed through tiny needle-like punctures. Laser energy is delivered into the areas of loose tissue, tightening these areas and reducing the space for fluid accumulation. The laser stimulates collagen production and improves skin elasticity, helping to firm the area around the lower eyelids and cheekbones.

This procedure is ideal for patients seeking non-surgical options with minimal downtime. It offers noticeable results in both skin texture and contour. Our expert specialists perform the treatment, ensuring safe and effective outcomes. It is important to note that Endolift laser is not always effective at treating this area.

Dissolving of Filler Injections

When fillers have been overused or improperly placed in the under-eye area, they can contribute to the appearance of malar bags and festoons. As such, facial fillers should rarely be used to improve malar bags, as the hyaluronic acid will almost always exacerbate the problem.

In such cases, dissolving the filler using hyaluronidase can be an effective solution. This enzyme breaks down the filler material, helping to restore a more natural and balanced appearance. The procedure is quick, with results visible almost immediately, and it allows patients to reset their treatment plan, opting for a more tailored approach going forward.

Combined Blepharoplasty with Midface Lifting

A combined blepharoplasty with midface lifting may be recommended for patients with more pronounced malar bags or festoons. This surgical approach addresses the under-eye area and lifts the midface to restore youthful contours and improve facial symmetry.

Malar bags are best addressed through surgical techniques, including reducing the lower eyelid bag, lifting the midface, and releasing the retaining ligaments. A midface lift helps tighten loose tissue in the cheek area, which reduces the likelihood of fluid accumulation. However, in dense tissues, surgery may not fully resolve fluid retention (oedema).

The surgery is performed through a scar just underneath the eyelashes. By tightening both the eyelids and the cheeks, this procedure provides a more comprehensive rejuvenation, reducing puffiness and sagging while creating a natural, refreshed look. Recovery times vary, but patients usually experience long-lasting results.

Direct Excision

Direct excision may be necessary for severe festoons or malar bags. This surgical procedure removes excess skin, fat, or tissue in the affected areas. Direct excision offers a permanent solution for reducing sagging and puffiness by physically excising the problematic tissue.

The surgery is performed carefully to ensure minimal scarring and a natural appearance. Results from this procedure are usually long-lasting, significantly improving facial contour and symmetry. However, it must be noted that scars can be unpredictable, and this type of surgery must be carried out cautiously.

Fat Transfer

Fat transfer can sometimes be used to fill the areas under the malar bag and to disguise the contour abnormalities.

After the procedure

After treatment for malar bags, patients generally experience a noticeable reduction in swelling and puffiness around the cheekbones. Recovery times can vary depending on the type of procedure, but mild swelling and bruising are common and typically subside within a few weeks.

Non-invasive treatments often have quicker recovery periods, while surgical options may take longer for full results to be visible. Post-treatment care is crucial for maintaining optimal outcomes, and patients can expect a smoother, rejuvenated appearance.

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Malar Bags and Festoon Treatment Before and After

At The Ezra Clinic, we take pride in showcasing real patient transformations through our Before and After gallery. Our under-eye bags treatment results demonstrate a significant improvement in facial contours, with reduced puffiness and tighter skin around the eyes and cheekbones.

Midface Lifting and Blepharoplasty

This approach is usually recommended for mild cases of malar bags, where internal tissue stretching can help reduce fluid buildup in the cheeks. The surgery involves a discreet incision just beneath the eyelashes, resulting in minimal scarring. Patients usually see significant improvement within 6 months after surgery.

Endolift Laser

The Endolift laser procedure uses tiny needle-like punctures to deliver laser energy to loose tissues, tightening them and reducing fluid retention. Significant results, including reduced malar bags, are often seen just one month after treatment.

Direct Excision of Festoons

For severe festoons, direct excision is required. This procedure involves removing the festoon and suturing the skin back together. While the results can be impressive, with barely noticeable scars after 3 months, caution is necessary as scar formation can be unpredictable.

What our patients say

“Prof Ezra and his team provided exceptional care and professionalism throughout my surgery, inspiring confidence and making the experience highly positive.”

– Ann l

Book a consultation

FAQ

Do Malar Bags and Festoons Worsen With Age?

Yes, as we age, the skin loses elasticity, and the muscles weaken, which can cause malar bags and festoons to become more prominent. Factors such as fluid retention and sun damage may also exacerbate the condition.

Are Malar Bags Permanent?

Malar bags can persist and worsen over time without treatment, but treatments such as laser therapy, fat transfer or surgery can significantly reduce their appearance.

Can Malar Bags Disappear?

While malar bags are unlikely to disappear independently, treatments like Endolift Laser, blepharoplasty, or midface lifting can effectively minimise or eliminate them.

How much does Under Eye Bags Treatment cost?

The cost of under-eye bag treatment at The Ezra Clinic varies depending on the procedure selected and the case’s complexity.