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There is much to be said about our eyes when it comes to appearance. When we are speaking with people we are also told how important eye contact is.

When we are being intimate with someone we are said to gaze into their eyes. This is one reason why people are keen to make sure that their eyes and that general area look as good as possible. Festoons, also known as malar pads, festoon eye bags, and malar fat pads, can detract from an otherwise attractive appearance.

People are keen to find the treatments that are available for festoons. They may already be affected by dark circles under the eyes and the addition of festoon eye bags can make this problem appear worse. Those who suffer from this condition find that their self-confidence is severely affected. There may be a degree of covering up with make-up, but this is a less than ideal solution. Here, we are going to take a look at what festoons actually are. We are also going to take a look at the treatments that exist and how effective these are. 


What Are Malar Fat Pads?

Festoon refers to the bulge of skin and soft tissue that is present around the lower eyelid - this is therefore different to droopy eyelids above the eyes, and requires a slightly different patient journey. It is made from lax skin and thinned out muscle. The tissue underneath becomes swollen with fluid which causes malar pads before a full-blown festoon. There is often a misdiagnosis with festoons as many people believe that they are eye bags. However, there are some distinct differences:

  • Bags appear as fat protruding through the thin skin and affect the lower eyelid. Whereas festoons still protrude they affect the upper part of the cheek
  • Bags are puffy and can feel almost firm to touch. Festoons feel softer and almost squishy. 
  • Bags and festoons can merge into what appears to be one single protrusion.

What Causes Festoon Eye Bags?

Festoon eye bags are more than likely one of those things where you have your parents to blame again. As is the case with many conditions that affect our appearances, there is often a role played by genetics. While there may be a hereditary predisposition to festoons, there are things that can increase the chances of their appearance:

  • Smoking
  • Sun exposure
  • Ageing (not something that we can avoid just yet)
  • Being fair-skinned (not a cause but makes the appearance more obvious)

The underlying cause of festoons is a structural problem with the skin. It is due to the loosening of the muscle that helps us to close our eyelids. 


What Happens to Festoons As We Age?

As is often the (unfortunate) case, like many other conditions, festoons are something that worsens with age. As time goes on, damage has been caused to our skin by the likes of sun exposure. The older we become, the more exposure we have had. Alongside this is the natural ageing process. The older we become the more our skin lacks elasticity. This makes the appearance of malar fat pads more obvious.

The ageing process sees our skin lacking in collagen too. We also experience a loss of fat which makes the skin appear much thinner alongside being paler. There are times when the skin even becomes almost clear and in most cases, it will lose its previous smooth youthful appearance. As this natural process takes place, the appearance of festoon eye bags is exaggerated. 


What Else Can Make Malar Pads Look Worse?

As well as the impact that ageing has on the skin, some people experience oedema as they get older. This is where the body retains too much fluid. There are things that can worsen oedema such as underlying medical conditions and even a night out with heavy drinking and excessive eating. The fact that fluid is retained means that malar pads will often look worse in the morning. Being laid down causes the fluid to pool around the eyes and upper cheeks. During the day when we are physically active, the fluid moves around the body and is likely to settle around the ankles. 

Something else that can worsen the appearance of festoons is an injury or surgery around the eye. Either of these has the potential to cause additional swelling and will make festoons more pronounced until the swelling subsides.


What Surgical Treatments Are There for Festoon Eye Bags?

For those looking to rid themselves of festoons, there are a number of options open to them. During early stages, it may be that the appearance of festoon eye bags can be managed with non-surgical options. When they are no longer proving effective, there are three main types of surgery to consider:

Blepharoplasty 

Also referred to as ‘eyelid reduction’ or ‘eye bag removal’, this is the most effective procedure when it comes to festoons. A blepharoplasty sees the removal of loose skin and excess fatty tissue. This leads to loose muscles being tightened and gives a more youthful appearance. The results can be seen almost straight away which makes this the best surgical option. This may be used in combination with a mid facelift as well as some of the non-surgical options. 

Mid Facelift

A mid facelift - or mico facelift - stretches the loose tissue in the face and can lessen the chances of fluid collecting there. It specifically targets the mid-face. It is often the case that the best results are achieved by combining this with eyelid surgery. One thing to be aware of is that surgery will initially cause swelling which may actually make malar fat pads look worse. This will correct itself once the swelling lessens.

Direct Excision

This is generally reserved for severe cases of festoons where there is lots of overhanging skin and muscle. It sees the dead space where fluid can collect being removed before the skin is stitched back together. This method works extremely well but is likely to leave a scar. 


What Are the Non-Surgical Treatments for Malar Fat Pads?

Treatment for malar fat pads is not always easy. The suitability of any treatment will depend upon the extent of your condition. Some of the non-surgical treatments that are available include:

These non-surgical options all work by tightening the skin and so reducing the appearance of festoons. 

To find out how your festoons and be treated, it is best to make an appointment with one of our specialists. Here, you can be guided as to the treatment that best suits your needs. 


Words From Our Founder

Mr. Bryan Mayou

Festoons can dramatically alter facial balance, affecting the overall appearance, not just under the eyes. Many patients feel that festoons make them look sad or unapproachable. Addressing this concern requires precision and expertise. By rejuvenating the delicate under-eye area, restoring smooth contours it is possible to enhance the entire face. This relatively simple procedure yields remarkable results, leaving patients looking and feeling younger. In my years as a plastic surgeon I have always advocated for small adjusments that have significant impacts on the appearance, allowing for better patient outcomes.
Mr. Bryan Mayou

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