Festoons and Malar Bags

Malar bags are swollen bags under the eyes, beneath the lower eyelid, and around the cheek
Festoons are excess skin over Malar bag
Common feature of mid-face ageing, leading to an older, tired appearance
Severe cases may obstruct peripheral vision

Complex and multiple causes: including sun exposure, smoking, ageing, and genetics
Structural issues in the skin of the lower lid and cheek due to muscle loosening
Worsened by fluid retention (oedema), often more noticeable in the morning

**Combined Blepharoplasty with Midface Lifting**
- Debulks lower lid bag and lifts midface to reduce fluid collection
- May involve post-surgical swelling
**Direct Excision**
- Suitable for severe festoons with significant overhanging skin and muscle
- Directly excises tissues and minimizes scarring
**Endolift Laser**
- Delivers laser energy beneath the skin to stimulate collagen production and tighten loose areas
- Long-term effectiveness still unclear
. **Dissolving of Filler Injections**
- Fillers can exacerbate malar bags; dissolving them may significantly improve the condition

Varies by procedure and individual patient
Common post-procedure swelling and bruising, usually subsiding after a week
Ice packs and over-the-counter painkillers recommended
Longer recovery time for combined procedures, avoiding strenuous activities until healing is complete

**Midface Lifting and Blepharoplasty**: Reduces fluid accumulation; results visible 6 months post-surgery
**Endolift Laser**: Tightens loose tissue; significant improvement seen one month post-procedure
**Direct Excision of Festoons**: Effective for severe cases; minimal scarring with careful surgery; results visible 3 months post-surgery

All skin incisions leave scars, but eyelids heal with minimal residual scarring.
Upper eyelid scars are hidden in the skin crease and are well disguised.
Lower eyelid scars are hidden under the lashes and barely noticeable.
Small lateral scars in the crow’s feet area may be more noticeable.
Noticeable scarring is extremely rare compared to other facial surgeries like facelifts.
Eyelid fibroblasts have a lower propensity to form scars, explaining minimal scarring in this area.

- Blepharoplasty results are long-lasting and typically do not require a second procedure.
Results can last between 10-15 years, though natural ageing continues.