Expert Malar Bag/Festoons Treatments
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What is Festoon and Malar Bags Treatment?

Festoons and malar bags are a common concern for many individuals. “Malar bags” is a broad anatomical umbrella term used to describe malar oedema, malar mounds and festoons that clinically appear as water-logged swollen “saddle bags” at the junction of the lower eyelid and upper cheek.
Given the multifaceted nature of festoons and malar bags, there is no single optimal treatment approach. It is likely that the best management of festoons and malar bags involves a combination of individualised interventions. Unlike eye bags, the appearance of festoons and malar bags is not significantly affected by up-gaze and down-gaze. Dr. Sabrina Shah-Desai, a renowned UK oculoplastic surgeon, has over 20 years of experience in treating this multifactorial condition.

Advantages of Malar Bags Treatment

Orbicularis Muscle Tightening

Improved contour and reduced appearance of malar bags, resulting in a more youthful appearance.

Natural Muscle Tightening

The treatment enhances facial definition and restores a more natural, rested, and rejuvenated look.

Long-Lasting Result

Long-lasting improvement in the appearance of malar bags, providing sustained aesthetic benefits.

Invisible Scarring

Minimised risk of noticeable scarring or post-treatment marks, promoting a seamless and natural outcome.

How Does the Malar Bags
Treatment Work?

While surgical treatment is a classic option for addressing festoons and malar bags, it is essential to note that revisions are not uncommon, and postoperative results may require further enhancement through tailored non-surgical procedures. Non-surgical options provide an exciting alternative for mild to moderate festoons and malar bags. However, it’s important to consider that these treatments may require repeated sessions due to temporary improvements or insufficient rejuvenation.

For Mild to Moderate Malar Bags:

Tetracycline Injection: Injection with 2% tetracycline may modestly reduce malar bags by triggering collagen and fibrin production. Results appear around 3 months, with repeat injections possible.

Ellanse or Hyaluronic Acid Gel Filler: Injected strategically into the cheek, fillers can camouflage mild swelling and support the malar area. Dr. Sabrina Shah-Desai prefers to use Ellanse or a hyaluronic acid gel filler with less water-binding capacity to avoid worsening the issue.

Radiofrequency Micro-Needling: This treatment uses radiofrequency energy to tighten loose skin and improve the appearance of malar bags. It requires a series of 3 treatments every 4-6 weeks and offers long-term results with minimal side effects.

For Moderate to Severe Malar Bags:

Endolift Laser: Endolift Laser uses laser energy to target the fat compartment beneath your skin, specifically in the malar area. Endolift laser has shown promising results in reducing the appearance of malar bags by up to 50% within 3-6 months after one treatment. Additionally, downtime is significantly less compared to surgery, with most patients experiencing swelling and bruising that resolves within 2 weeks.

For Severe or Persistent Malar Bags:

Direct Excision: This is an option for typically elderly patients with severe and persistent festoons. It may also be suitable for those who prioritise minimising scars over eliminating the malar bags themselves. This is a quick procedure performed under local anaesthesia with minimal downtime (1-2 weeks). However, it’s important to note that this procedure is not suitable for patients with extensive orbicularis hypertrophy, attenuation or ptotic midface. Additionally, it leaves a visible scar where the festoon was removed.

Extended Lower Lid Blepharoplasty with Midface Lift: This procedure is typically chosen by patients with severe, persistent malar edema, mounds, or festoons, that are persistent or recurrent, following minimally invasive non-surgical treatments. The advantage of this surgery is that it can address both eye bags and malar bags simultaneously. However, it requires general or twilight anaesthesia and comes with a longer downtime of 2-12 weeks. Additionally, a small scar will be left at the outer corner of the eye.

Treatment Summary

Dr. Sabrina Shah-Desai has a vast experience, spanning 2 decades, and is considered the “go to” UK Oculoplastic surgeon for treating this challenging multifactorial condition.

Although surgical treatment seem to be the classic option, with possible improved long-term stability, revisions are not uncommon and postoperative results often need to be further enhanced by tailored non-surgical procedures

Non-surgical options offer an exciting alternative for mild to moderate malar bags,
but require repeated treatments, due to temporary improvements or insufficient rejuvenation.

Thus the role of a single optimal treatment remains unclear, but it seems likely that malar bags are best managed by using a multifaceted approach with a variety of individualized interventions.

Unlike eye bags (fat bulges above the bony eye socket rim), up-gaze and down-gaze do not significantly affect the appearance of “malar bags”. “Malar bags” is a broad anatomical umbrella term used to describe malar edema, malar mounds and festoons that clinically appear as water-logged swollen “saddle bags” at the junction of the lower eyelid-and upper cheek.

Malar Edema

Malar edema is fluid accumulation over the eminence of the cheek. It can vary in severity often worsening after salty meals or in the morning. The consistency is usually soft and compressible. There is occasionally pitting with a slight bluish or purple discoloration. Cardiac, renal, or hepatic insufficiency, hypothyroidism, surgical or under eye filler injections, as well as allergies may be causative.

Malar Mounds

Malar mounds are chronic soft tissue swelling within upper cheek. This permanent soft tissue bulge usually contains hypertrophic fat or muscle which has descended. Often there is a familial history of mounds and can be seen from childhood.

Festoons

Fluid or fat filled hammocks of lax skin and orbicularis muscle below the infraorbital rim are referred to as malar festoons. Festoons are typically senile and have progressed from malar mounds and edema to become evident in the elderly, often seen in severely sun damaged skin or in smokers

Malar Bags Treatment Before and After

See the Festoon treatment before and after results below achieved by Dr. Sabrina.

Disclaimer : Your results may vary. Any specific claims or duration of results vary for each patient and are not guaranteed.

Meet the Expert: Dr. Sabrina Shah-Desai

With over two decades of surgical and non-surgical experience, Dr. Sabrina Shah-Desai is currently considered to be one of the safest, most experienced oculoplastic surgeons in the UK. Her extensive training, in combination with her caring and empathetic nature, makes her a natural choice for patients seeking the very best care. For this reason, Dr. Sabrina Shah-Desai appears consistently in Tatler magazine as one of the UK’s “Best Eye Surgeon” and “Top Doctors” since 2019, and is the recipient of multiple awards, including “Best Aesthetic Doctor” Safety in Beauty Diamond Award 2023, “Consultant Surgeon of the Year”, “Best Surgical Result” Aesthetic Awards 2021 & Highly Commended “Consultant Surgeon of the Year” Aesthetic Awards 2022. She was voted by “MyFaceMyBody” as one of the Global 100 most influential aesthetic practitioners in 2019 & 2020.

Dr. Sabrina - Upper Eyelid Blepharoplasty Surgeon- Signature

Malar Bags Treatment Cost in London

Prices are a guide; your doctor will calculate the total cost of festoon plastic surgery during the consultation.
Hyalase for filler festoons from £450
Surgery – direct excision from £6000
Extended lower lid blepharoplasty from £10,000
Hyaluronidase Injection Cost: £400 per area
Tetracycline Injection Cost: £300 per injection
Dermal Fillers Cost: from £600 per syringe
Radiofrequency Micro-Needling Cost: £650 per treatment
Endolift Laser Cost Starts from £2000
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Patient Questions About Malar Bags Treatment

Frequently Asked Questions

Are malar bags permanent?

Malar mounds, sometimes referred to as malar bags, can really be permanent. Malar bags are a type of persistent swelling of soft tissues that can be brought on by either descending muscle or hypertrophic fat. They might have a family history and have been around since childhood. However, both surgical and non-surgical procedures such as radiofrequency microneedling, direct excision, endolift laser, prolonged blepharoplasty, etc., can improve them.

Can malar bags disappear?

Most people develop bags under the eyes at some point, often due to factors like lack of sleep, poor diet, and dehydration. In many cases, these bags can go away on their own when lifestyle changes are made to improve sleep and hydration.

Do malar bags go away with weight loss?

Losing weight is not likely to reduce under-eye bags, and in some cases, it may even make them more noticeable. Rapid weight loss can cause the fat pockets in the face to shrink, creating a sunken look under the eyes.

Can lack of sleep cause malar bags?

Unhealthy eating habits, smoking, excessive alcohol use, and sleep deprivation can all lead to the formation of under-eye bags. Lack of sleep specifically can cause the skin to appear dull and pale, making under-eye bags more prominent.

Can malar bags and festoons get worse as you get older?

Yes, as you grow older, malar bags and festoons can get worse. This happens because the skin’s collagen and elastin weaken over time, and the fat around the eyes can bulge more.

What causes malar bags and festoons?

There are a few reasons why malar bags and festoons can develop. Below are some of them:

  • Weakening of elastin and collagen in the skin
  • Ageing
  • Sun damage
  • Fat herniation
  • Genetics

What are festoon and malar bags?

Malar bags are swellings or pouches that can develop under the lower eyelids. They can also be called tear trough deformities, periorbital puffiness, malar oedema, malar mounds, or secondary bags. They can be caused by excess fluid collection or accumulation, leading to mild swelling, along with changes in the skin and fat compartments.

What can I expect after the treatment for malar bags?

After getting rid of malar bags, patients might have some swelling, bruising, and tightness. These side effects can vary in how severe they are, depending on the type of treatment used.

  • Swelling and bruising: This usually gets better within a week. Using ice packs and eye drops can make it feel better.
  • Stitches: These are usually taken out after a week.
  • Pain: You can take painkillers that you can buy without a prescription to help with any pain.

If the treatment was done along with other procedures, like a midface lift, it might take longer to recover. You should avoid doing things like heavy lifting and exercise until you have fully healed.

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