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It is made up of lax skin and thinned out muscle as a cascading drape. It and the underlying fibrous tissue is swollen with tissue fluid. It first shows as swelling, becoming a mound (malar pads) and then a full-blown festoon.

There is a hereditary predisposition, but it becomes more obvious with age and the destruction of skin elasticity by the sun. Anything which increases oedema makes the appearance worse, and this could be anything from metabolic disease to a heavy night out. It will always be worse in the morning after lying flat. Later in the day, the excess fluid will redistribute itself around the body, perhaps ending up as swollen ankles!

A particular issue is extra swelling of the malar pads or festoons following injury or surgery of the eyelids or above. Any surgical attempt to correct the problem will cause increased swelling initially, which takes some months to settle. Be warned!

Malar pads and festoons often come associated with eye bags and surplus skin of both the upper and lower eyelids (dermatochalasis). Surgery to these causes prolonged worsening of the malar pads (festoons) below. Happily, it does eventually settle.

Treatment is difficult and elected therapy is based on the severity of the condition. Tightening skin by fractional laser, ultherapy, radiofrequency or chemical peel is effective in the earlier stages and as an adjunct to surgery. Mid facelift is a radical treatment. When all else fails then direct excision works well but will leave a scar. This is not a problem for those who always wear make-up.

In some cases, crepy wrinkles overlying festoons in the skin are removed using lasers.

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