Festoons and Malar Bags Treatment

Festoons and malar bags are forms of swelling or sagging that appear beneath the eyes or on the cheekbones. They are often caused by fluid retention, ageing, or weakened facial muscles. Left untreated, they may worsen over time, leading to more pronounced puffiness and aesthetic concerns.

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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Monthly payment plans to suit every budget, including 0% finance and payment options starting from just £175.31. Terms and conditions apply.

What Are Festoons and Malar Bags?

Malar bags are areas of swelling or fullness that develop over the cheekbones, just below the lower eyelids. Unlike traditional under-eye bags, which sit directly beneath the eyes, malar bags affect the upper cheek and can make the midface appear swollen or fatigued. They usually develop gradually as the face’s supporting tissues weaken with age, allowing fluid to collect in the area. Genetics, sun damage and changes in skin elasticity can also contribute to their formation.

Festoons are a more advanced form of swelling that appears as folds or drapes of skin and soft tissue extending from the lower eyelids onto the upper cheeks. While they may develop from longstanding malar bags, they can also occur independently due to skin laxity, chronic oedema, ageing or previous filler treatments that have disrupted the delicate balance of the tissues beneath the eyes.

Festoons and Malar Bags Treatments Available at The Ezra Clinic

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 areas of loose tissue, tightening them and reducing 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 to ensure safe, effective outcomes. Endolift laser is not always effective for 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 restore a more natural, balanced appearance. The procedure is quick, with results visible almost immediately, and it allows patients to reset their treatment plan and opt for a more tailored approach going forward.

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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 minimise scarring and achieve a natural appearance. Results from this procedure are usually long-lasting and significantly improve facial contour and symmetry. However, scars can be unpredictable, so this type of surgery must be performed cautiously.

Fat Transfer

Fat transfer can soften contour irregularities beneath malar bags by restoring volume to areas where age-related fat loss has occurred. Rather than treating the swelling itself, the procedure improves the transition between the lower eyelid and the cheek, creating a smoother and more balanced appearance.

Depending on the patient’s anatomy, fat transfer may be performed on its own or combined with other procedures to achieve a more harmonious overall result.

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Which Treatment Is Right for You?

The most appropriate treatment depends on the cause of your festoons or malar bags, not their appearance alone. During your consultation, your surgeon will assess your skin quality, the position of your facial tissues, the presence of fluid retention, and any previous cosmetic treatments before recommending the option most likely to achieve a natural-looking result.

Treatment	Best suited for	Typical candidates
Endolift Laser	Mild skin laxity	Patients seeking a minimally invasive option
Blepharoplasty with Midface Lift	Moderate to severe malar bags	Patients with structural ageing and tissue descent
Direct Excision	Severe festoons	Patients with significant excess skin and soft tissue
Fat Transfer	Volume deficiency and contour irregularities	Patients requiring facial volume restoration
Filler Dissolving	Filler-related swelling	Patients with previous hyaluronic acid filler contributing to malar bags or festoons

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Malar Bags and Festoon Treatment Before and After

Every patient presents with a unique combination of skin quality, facial anatomy and underlying tissue changes, which is why treatment outcomes vary from person to person. The most appropriate procedure depends on the cause and severity of your festoons or malar bags, not their appearance alone.

At The Ezra Clinic, our goal is to achieve subtle, natural-looking improvements that restore a fresher, more rested appearance while preserving your individual facial features. We encourage you to explore our Before and After gallery to see real patient outcomes after treatment for festoons and malar bags.

Your Treatment Journey

Consultation

Your treatment begins with a detailed consultation with one of our specialist oculoplastic surgeons. We will assess your facial anatomy, identify the underlying cause of your concerns and discuss the treatment options best suited to your individual needs.

Before Treatment

Before your procedure, you will receive personalised preparation instructions based on your treatment plan. We will also review your medical history, explain the procedure and ensure you feel fully informed before treatment.

During Treatment

Your experience will vary depending on the procedure selected. Non-surgical treatments are typically performed under local anaesthetic with minimal downtime, while surgical procedures require a more comprehensive approach to achieve long-lasting results.

Recovery and Aftercare

Recovery depends on the treatment performed. Mild swelling and bruising are common, particularly after surgery, and you will receive personalised aftercare guidance along with follow-up appointments to support your recovery.

FAQ

What are malar bags under the eyes?

Malar bags are areas of swelling that develop over the cheekbones, just below the lower eyelids. Unlike traditional under-eye bags, they affect the upper cheek and are often caused by a combination of ageing, genetics, weakened facial support structures and fluid retention.

How can I tighten malar bags naturally without surgery?

Lifestyle changes such as reducing salt intake, staying hydrated and getting enough sleep may help minimise temporary swelling, but they cannot correct the structural changes responsible for true malar bags. If the appearance is caused by skin laxity or weakened facial tissues, medical or surgical treatment is often required to achieve lasting improvement.

What makes malar bags worse?

Malar bags may become more noticeable with age as the skin loses elasticity and the supporting tissues weaken. Fluid retention, sun damage, smoking and previous filler treatments can also contribute to increased swelling in some patients.

What causes festoons under the eyes?

Festoons develop when the skin and soft tissues beneath the lower eyelids become loose and begin to retain fluid. Ageing, genetics, chronic oedema, sun damage and previous cosmetic treatments may all play a role. Identifying the underlying cause is an important step in choosing the most appropriate treatment.

How can festoons be treated without surgery?

Some patients may benefit from non-surgical treatments such as Endolift Laser or dissolving previous filler if it is contributing to the problem. However, not all festoons can be treated without surgery. The most suitable approach depends on the severity of the condition and the underlying cause.

Can festoons come and go?

Mild swelling caused by fluid retention may fluctuate throughout the day, making festoons appear more or less noticeable. However, established festoons caused by skin laxity and structural changes do not usually resolve on their own and often become more pronounced over time.

Malar bags vs festoons – what is the difference?

Although the terms are often used interchangeably, malar bags and festoons are different conditions. Malar bags appear as swelling over the cheekbones, while festoons are folds of loose skin and soft tissue that extend from the lower eyelids onto the upper cheeks.

Read our detailed guide to learn more about the differences between malar bags and festoons and how each condition is treated.

Do Malar Bags and Festoons Worsen With Age?

Yes, as we age, skin loses elasticity and muscles weaken, which can make malar bags and festoons more prominent. Fluid retention and sun damage may also worsen the condition.

Contact us

If you are interested in any of the treatments we offer, or require any clarifications, we would love to hear from you. We deal with all issues relating to the Harley Street and Moorfields practices. You can reach us by phone, by email or by filling out the contact form below.

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