Festoons and malar bags are swellings that sit lower than typical eye bags, over the top of the cheekbone. Malar bags are usually soft collections of fluid, while festoons are folds of loose skin and muscle that sag like a hammock. Both are harder to treat than ordinary under-eye bags, and the right approach depends on which is present, so an expert assessment matters.
Where they sit, and how they differ from eye bags
Ordinary lower eyelid bags are caused by fat pushing forward from behind the eyelid, directly under the lashes. Festoons and malar bags lie further down, on the upper cheek below the bony rim of the eye socket.
Malar oedema (malar bags) is a puffy, fluid-filled swelling, often worse in the morning and variable from day to day. Festoons are more structural: pouches of lax skin and orbicularis muscle that hang over the cheek and may also contain fluid or fat. Some people have both, alongside standard eyelid bags.
What causes them
- Anatomy: a natural tight band of tissue at the lid-cheek junction can trap fluid above it.
- Ageing: skin and muscle lose elasticity and begin to fold.
- Sun damage: weakens the skin of the upper cheek over time.
- Fluid retention: salt, alcohol, allergies, poor sleep and hormonal change can all make malar swelling fluctuate.
- Smoking: damages skin quality and circulation.
- Previous treatment: filler placed near the tear trough or cheek can sometimes worsen fluid swelling in susceptible people.
- Medical conditions: thyroid, kidney or heart problems occasionally cause facial swelling and should be ruled out if it appears suddenly.
Self-care that can reduce swelling
Because malar bags contain fluid, simple measures can make a noticeable difference. Sleeping with the head slightly raised, reducing salt and alcohol, treating hay fever or other allergies and using cold compresses in the morning often reduce puffiness.
Consistent sun protection helps preserve the skin of the upper cheek. These steps do not remove established festoons, but they can make fluctuating swelling less prominent and are worth trying before any procedure.
Why festoons are a surgical challenge
Festoons sit below the area treated by a standard lower blepharoplasty, so routine eyelid surgery alone may leave them unchanged or even make them more obvious by contrast. Lymphatic drainage in this area is delicate, and some surgical approaches can temporarily increase swelling.
Dermal fillers are generally unsuitable for festoons and malar bags; filler can attract fluid and make swelling worse. Honest expectations are therefore essential. Improvement is realistic for many people, but complete removal is often not.
Surgical options
Where festoons are significant, an extended lower blepharoplasty may be considered. This can involve lifting and tightening the orbicularis muscle, removing a conservative amount of skin, releasing tethering at the lid-cheek junction and supporting the lower lid. In some patients a direct excision of a festoon is discussed, accepting a scar on the cheek in exchange for a more reliable reduction.
Mr Nassab will examine the lower lid, cheek and skin quality, check whether swelling fluctuates, and explain which technique, if any, is likely to help. Lower blepharoplasty is priced from £7,500; more complex or extended surgery is quoted at consultation.
Recovery and outlook
Swelling after festoon surgery tends to last longer than after standard eyelid surgery, sometimes for several weeks to a few months, because the lymphatic drainage of the area recovers slowly. Head elevation, cold compresses and gentle massage when advised can help.
Results are judged at around six months or later, once the tissues have softened and any residual fluid has cleared. Improvement can be meaningful, but further swelling may return with age, salt intake or allergies, so ongoing self-care remains important.
Frequently Asked Questions
Are festoons the same as eye bags?
No. Eye bags sit directly under the lashes and are usually caused by fat. Festoons are lower, on the upper cheek, and involve lax skin and muscle, sometimes with fluid.
Can filler treat malar bags?
Filler is generally avoided, as it can attract fluid and worsen malar swelling. Careful assessment is needed before any injectable near this area.
Why are malar bags often worse in the morning?
Fluid collects overnight while lying flat. Sleeping with the head raised and reducing salt and alcohol often helps.
Will blepharoplasty remove festoons?
Standard lower blepharoplasty often does not address festoons. An extended technique may help, and Mr Nassab will explain what is realistic.
When should facial swelling be checked by a GP?
Yes, if swelling appears suddenly, affects other areas, or comes with other symptoms, so that thyroid, kidney or heart causes can be checked.
