What malar bags and festoons are
Malar bags are soft swellings that sit on the upper cheek, below the lower eyelid and the under eye area. They are not the same as ordinary under eye bags, which sit directly beneath the lash line. Malar bags sit lower, over the cheekbone, and often look like a cushion or crescent on each side.
Festoons is the term often used for the more pronounced version: hanging folds or pouches of skin and tissue across the upper cheek, sometimes in more than 1 layer. In everyday conversation the 2 words overlap, and many people simply describe them as bags on the cheekbones.
They can be stubborn and are often worse in the morning. They are also among the more difficult areas of the face to treat well, which is why an honest assessment matters before you choose anything.
What causes them
Malar bags usually come from a combination of factors rather than a single cause.
- Loosening skin and supporting tissue over the cheekbone with age.
- Fluid collecting in the area, which is why they can vary from day to day.
- Small amounts of fat in the tissue of the upper cheek.
- Long term sun exposure, which weakens the skin.
- Smoking, which affects skin quality.
- Family traits: some people notice them from a relatively young age.
Because fluid plays a part, salt, alcohol, poor sleep and allergies can make them look worse for a time. If they appear suddenly, or on 1 side only, see your GP first, as they can occasionally reflect a medical issue rather than ageing.
Treatment options compared
| Option | What it aims to do | Points to consider |
|---|---|---|
| Lifestyle changes | Reduce fluid related puffiness | Helps day to day variation, not the underlying bag |
| Skincare and sun protection | Protect and improve skin quality | Supportive only; will not lift the bag |
| Filler around the cheek or under eye | Restore volume nearby | Can sometimes make malar swelling look worse; needs careful judgement |
| Endolift | Tighten the tissue and reduce small fat deposits | Best for mild to moderate malar bags; results build over months |
| Surgery | Remove or reposition tissue | Often needed for large or hanging festoons |
Lifestyle and skincare
Sleeping with your head slightly raised, reducing salt and alcohol, and treating any allergies can reduce the puffiness that comes and goes. Daily sun protection helps protect the skin long term. These steps are worthwhile but rarely change an established bag on their own.
Filler
Filler can help hollows near the eye, but malar bags often involve fluid and loose tissue rather than lost volume. Placing filler in or near the area can sometimes make swelling more noticeable. If filler has been used recently, tell any doctor assessing you, as recent fillers in the area need discussion before Endolift.
Endolift
Endolift works beneath the skin through a tiny entry point, using a fibre 200 to 600 microns wide under local anaesthetic, without incisions or stitches. At 1470 nm the laser is strongly absorbed by water and fat. It contracts the fibrous bands under the skin, can liquefy small fat deposits and triggers collagen remodelling, in which weaker Type III collagen is replaced by stronger Type I. Results improve for around 6 months.
For malar bags this can firm the tissue over the cheekbone and reduce the cushion effect. It suits mild to moderate cases best. Large festoons with heavy, hanging skin are usually better treated surgically. Swelling is common after treatment in this area, along with bruising, redness, tenderness and temporary numbness, and some firmness can take 1 to 2 weeks or longer to settle. Rarer risks include burns, skin irregularity, infection and scarring at entry points. Results vary and can last up to 2 years. Our under eyes page explains how this area is approached.
Surgery
For pronounced festoons, surgery to remove or reposition tissue may give the clearest improvement. It involves incisions and a longer recovery, and should be discussed with a surgeon experienced in this area. You can compare the broader trade offs on our Endolift vs facelift page.
Dr Seth's view "Malar bags are an area where I am particularly careful. Some respond well to Endolift, because the tissue firms and the small amount of fat reduces. Others are mainly fluid, or the skin is too heavy, and then a laser is not the answer. I would rather explain that at the start than have someone expect a change that this treatment cannot give."
How to tell which group you are in
- Note whether the bags change much from morning to evening or day to day. Large variation suggests fluid plays a big part.
- Look at whether the skin over the bag hangs or folds. Hanging folds point towards festoons.
- Think about recent treatment in the area, such as filler.
- Take photos in natural light from the front and both sides, so a doctor can assess them properly. Our guide to taking photos for an Endolift assessment explains how.
At TK Medispa, malar bags can be treated as a single face area for £1,500, or as part of the full face for £2,500, all inclusive.
Next step
Malar bags vary so much that a personal opinion is the most useful thing you can get. Send 3 photos (front, left and right, in natural light) for Dr Seth's free assessment. He will tell you honestly whether Endolift is likely to help, or whether another approach would suit you better. Send your photos to Dr Seth.
Questions people also ask
Are malar bags the same as under eye bags?
No. Under eye bags sit directly beneath the lower lashes, while malar bags sit lower, on the upper cheek over the cheekbone. They have different causes and often respond to different treatments, so it helps to have a doctor confirm which you have.
Can filler fix malar bags?
Usually not on its own. Malar bags often involve fluid and loose tissue rather than lost volume, and filler near the area can sometimes make swelling more noticeable. Filler may still help nearby hollows in some people, which is a decision for careful assessment.
Is swelling worse after Endolift for malar bags?
Swelling is common after treatment in this area and can be quite noticeable for several days. Most settles within days, while firmness and numbness can take 1 to 2 weeks or longer. Plan treatment with time to spare before any important event.
Will malar bags come back after Endolift?
Results can last up to 2 years, but ageing continues. How long the improvement holds depends on age, skin quality, sun exposure, smoking and how much fluid contributes. Some people choose to repeat treatment later.
This article is general information, not personal medical advice. Results vary between individuals and are not guaranteed. Endolift® and LASEmaR® are registered trademarks of Eufoton® S.r.l.