What are festoons and malar bags?
Festoons and malar bags (or malar mounds) are swollen bags that appear under the eyes, beneath the lower eyelid and around the cheek. Malar bags are a common feature of midface ageing and can result in an older and more tired appearance.
People with festoons or malar bags will have noticeably “puffier” eyes, resulting in a more extreme version of normal under-eye bags. In severe cases, festoons may cause serious problems, including an obstruction to the peripheral vision.
What causes malar bags?
The exact cause of malar bags is complex and often multifaceted. In general, several factors may contribute to their appearance, including sun exposure, smoking, the ageing process and genetics.
Malar bags are different to normal lower eyelid bags, as they are formed because of a structural problem in the skin of the lower lid and cheek areas. This is due to a loosening of the muscle in the face that helps close the eyelids (the orbicularis muscle), the skin and fat compartments. The tissues then form a concentrated loose area, which can be made worse by fluid retention (oedema), resulting in swelling. As such, many patients describe the bags as being worse in the morning and then getting better later in the day.
When malar bags become more severe, they can cause festoons, which are predominantly folds of skin, muscle and tissue.
What are the treatments for malar bags or festoons?
Patients with malar bags are much more challenging to treat than those with normal under-eye bags, so it is important to choose an experienced eye surgeon.
While blepharoplasty helps rejuvenate tired-looking eyes, individuals with festoons usually require additional treatment. It is, therefore, essential that festoons or malar bags are noted prior to undergoing any eyelid surgery, as conventional eyelid procedures, such as blepharoplasty, can make the problem worse. When lower eyelid bags are corrected through blepharoplasty, but festoons remain, the results can be more alarming than before.
There are several different treatments available for malar mounds:
Endolift laser is a new procedure for treating malar bags. This technology delivers laser energy beneath the skin and is directed into the fat compartment. The aim is to begin a healing process and stimulate collagen production to help tighten the loose midface areas where excess fluid collects.
As this a relatively new procedure, the long-term effectiveness is still unclear, but the before and after images on this page help demonstrate the potential benefits of undergoing laser treatment for malar bags.
Dissolving of filler injections
A very common problem seen in our clinic is the worsening of malar bags as a result of previous filler injections. Fillers generally cause swelling, which can make festoons more prominent. As such, facial fillers should rarely be used to improve malar bags, as the hyaluronic acid will almost always exacerbate the problem.
With malar bags or festoons, the aim is to flatten, not inflate. If you have had filler injections in this area, you will be asked to have these dissolved. The removal of the filler alone is likely to significantly improve the malar bags if the volume of filler has been substantial.
Combined blepharoplasty with Midface lifting
Malar bags can only be surgically improved by a combined effort of debulking the lower lid bag, midface lifting and release of the retaining ligaments.A midface lift will also stretch the loose tissues in the cheek, reducing the risk of excess fluid collection. However, if the tissues are dense, it is unlikely that surgery will successfully relieve the problem of excess fluid collection (oedema). There is also the added risk of post-surgical swelling, which may take some time to settle.
Patients will be advised on all aspects of the treatment, including potential complications, as part of their initial consultation. Please refer to the before and after images for the outcome of this type of treatment for festoons and malar bags.
Festoon excision treatment is available for patients with more severe festoons, where there are significant amounts of overhanging skin and muscle present.
The tissues can be directly excised, removing the dead space area where fluid collects. The skin is then carefully stitched together, and the scarring is usually minimal. This approach is appropriate for patients with more severe changes and natural lines in the skin.
How long does recovery from festoon treatment take?
Recovery times will vary according to the type of procedure undergone and the individual patient. Post-procedure swelling and bruising is common but should subside after a week. Ice packs can be applied to the treated area and over-the-counter painkillers can be used to minimise pain.For patients who have had festoon treatment in conjunction with other procedures, such as midface lift, the recovery time is often longer and some downtime may be necessary.
It is recommended to avoid strenuous activities, such as exercise and heavy lifting until the healing process is complete. Your surgeon will advise on post-operative care during your consultation, depending on the type of treatment you have.
Before and After
This is generally advised for more mild cases where internal stretching of the tissues can reduce the fluid accumulation in the cheek area. The surgery is performed through a scar just underneath the eyelashes. The image demonstrates the results 6 months after the surgery.
This 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 image shows the significant improvement of the malar bag one month after the Endolift laser was applied.
This is reserved for more severe cases. The festoon is directly excised and the skin is reapproximated and sutured together. These images show a very good result from festoon excision with the scar barely noticeable. However, it must be noted that scars can be unpredictable, and this type of surgery must be carried out with caution. The images demonstrate the result 3 months after the surgery.