Festoons and Malar Bags?

  • Swollen bags under the eyes, beneath the lower eyelid, and around the cheek
  • Common feature of midface ageing, leading to an older, tired appearance
  • Severe cases may obstruct peripheral vision              

Causes of Malar Bags

  • 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

Treatments for Malar Bags or Festoons

  • Challenging to treat; requires an experienced eye surgeon
  • Conventional eyelid surgery (blepharoplasty) may worsen the problem

Treatment Options

1 .Combined Blepharoplasty with Midface Lifting

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

Recovery from Festoon Treatment

  • 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

Before and After Results

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

Scarring from Blepharoplasty

  • 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.

Duration of Results:

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

Revision Surgery

  • Natural ageing may cause drooping and bulging of the eyelids to recur.
  • Revision surgery may be needed for refinements if the "ideal" or expected result is not achieved initially.

Additional Procedures

  • Other aesthetic procedures can be performed concurrently with blepharoplasty