Festoons can be one of the more difficult signs of facial ageing to treat.
Often described as malar bags, malar mounds or cheek bags, festoons appear as a persistent fullness or fold across the upper cheek, beneath the lower eyelid. They can create a tired, puffy or heavy appearance even when the rest of the face remains youthful.
At SAS Aesthetics in London, we take a detailed, anatomy-led approach to assessing festoons. Rather than treating the area in isolation, Dr Mahsa Saleki considers the relationship between the lower eyelid, cheek, skin quality, soft tissue and facial structure before recommending a treatment plan.
The aim is not simply to make the area smaller. It is to create a more balanced transition between the lower eyelid and cheek while preserving a natural appearance.
Festoons are areas of persistent fullness, swelling or laxity affecting the junction between the lower eyelid and upper cheek.
They are sometimes confused with ordinary under-eye bags or tear troughs, but they are not the same thing.
Festoons can involve a combination of:
Because several factors can contribute to their appearance, the correct diagnosis is particularly important.
Medical literature describes festoons as a complex spectrum that can overlap with malar oedema and malar mounds, making individual assessment essential.
One of the most common questions we are asked is whether festoons are simply another form of under-eye bag.
They are not.
Traditional lower eyelid bags are usually associated with changes around the orbital area, including protrusion or redistribution of orbital fat.
Festoons sit lower, around the malar or upper cheek region, and can have a different underlying anatomy involving fluid, skin and soft-tissue laxity.
These terms are often used interchangeably with festoons, although clinically they can describe slightly different presentations within the same broader spectrum.
This distinction matters because a treatment that is appropriate for tear troughs or conventional under-eye bags may not be appropriate for festoons.
There is rarely a single cause.
Festoons are thought to develop through a combination of age-related changes, tissue laxity, fluid retention and changes in the supporting structures of the midface.
As we age, collagen and elastin gradually decline and the tissues supporting the lower eyelid and cheek change. This can affect the smooth transition between the eye and cheek.
Other factors that may contribute include:
Festoons can therefore appear in otherwise healthy people and are not necessarily a reflection of lifestyle or overall health.
The skin and supporting tissues of the midface undergo gradual structural changes over time.
Collagen and elastin decline, facial ligaments and soft tissues change, and the relationship between the lower eyelid and cheek can become less defined.
At the same time, fluid may accumulate within the tissues.
The combination can produce the characteristic puffy, folded or swollen appearance associated with festoons.
This is why simply treating the surface of the skin may not always produce the desired result.
A detailed assessment is needed to understand what is contributing to the appearance in each individual.
In selected patients, non-surgical treatments may improve the appearance of festoons.
However, it is important to be realistic.
There is no single non-surgical treatment that reliably eliminates every festoon.
The most appropriate treatment depends on whether the predominant issue is fluid accumulation, skin laxity, tissue quality, volume distribution or a combination of these factors.
Recent clinical research has reported encouraging results from radiofrequency microneedling for mild to moderate festoons, including improvements in festoon severity and under-eye skin quality. However, the evidence base remains relatively limited and treatment should be individualised.
At SAS Aesthetics, we therefore assess the anatomy first and only recommend treatment where we believe it is appropriate.
Our approach is based on understanding why your festoons are present, rather than automatically treating the area with filler or a single device.
Depending on your individual presentation, treatment may involve technologies designed to improve:
Treatments that stimulate collagen and improve skin quality may be considered where laxity and reduced skin elasticity are contributing to the appearance.
Energy-based treatments may be appropriate for selected patients where skin and soft-tissue laxity are significant.
Where fluid accumulation or malar oedema contributes to the appearance, the underlying cause needs to be considered before treatment.
In some patients, the relationship between the cheek and lower eyelid contributes significantly to the appearance of festoons. In these cases, simply treating the skin may not address the underlying issue.
For some patients, the most natural result may come from combining different treatments over time rather than relying on one procedure.
Our philosophy is to treat the cause where possible, not simply camouflage the appearance.
This is an important distinction.
Patients with under-eye hollows often enquire about dermal filler. However, festoons are not simply a lack of volume.
Adding volume to an already swollen or prominent malar area may potentially make the appearance worse in an unsuitable patient.
Hyaluronic acid fillers can also contribute to persistent or recurrent periorbital oedema in some circumstances, particularly where lymphatic drainage is affected.
For this reason, we do not recommend treating every festoon with filler.
Instead, we assess the lower eyelid and cheek as a whole and determine whether adding volume would genuinely improve the overall facial balance.
You may be suitable for a non-surgical treatment approach if you have:
Your suitability will depend on the underlying anatomy and severity of the festoons.
Some patients with more pronounced festoons may require assessment by an oculoplastic or facial plastic surgeon, particularly where significant skin excess, muscle laxity or structural changes are present.
Your consultation begins with a detailed assessment of your facial anatomy.
Dr Mahsa Saleki will assess:
01 — The lower eyelid
Looking at the relationship between the eyelid, orbital area and cheek.
02 — The malar region
Assessing the position, consistency and prominence of the festoon or malar swelling.
03 — Skin quality
Considering elasticity, texture and the degree of skin laxity.
04 — Facial structure
Looking at the underlying cheek and midface architecture.
05 — Previous treatments
Previous fillers, devices, surgery or trauma can be relevant when assessing the area.
From this assessment, we can determine whether a non-surgical approach is appropriate or whether another form of specialist assessment would be more suitable.
Festoons can be persistent, particularly when there is significant structural laxity.
However, their appearance can fluctuate.
Factors such as fluid retention, inflammation, sleep, allergies and previous treatments may influence how prominent they appear at different times.
This is one reason why accurate diagnosis is important.
Treating temporary swelling as though it were permanent structural tissue can result in an inappropriate treatment plan.
Good skincare can support the overall quality and health of the skin, but skincare alone is unlikely to correct established festoons where there is significant tissue laxity or malar oedema.
A well-designed skincare programme may help support:
However, festoons involve structures beneath the surface of the skin, so topical skincare should be viewed as part of an overall skin-health strategy rather than a guaranteed treatment for established festoons.
SAS Aesthetics is a doctor-led aesthetic clinic in London, founded by Dr Mahsa Saleki.
Our approach is based on three principles:
We take an anatomy-led approach to facial aesthetics and carefully assess the underlying structures before recommending treatment.
The objective is not to create a generic aesthetic result. We consider how each treatment affects the balance of the entire face.
We believe that knowing when not to treat is just as important as knowing how to treat.
Our philosophy is based on creating a considered treatment journey rather than chasing individual imperfections.
If you are concerned about festoons, malar bags, malar mounds or persistent puffiness beneath the eyes, we recommend starting with a consultation.
Your festoons may not require the same treatment as someone else’s.
A detailed assessment allows us to determine what is contributing to the appearance and whether non-surgical treatment is appropriate for you.
Book your consultation with Dr Mahsa Saleki at SAS Aesthetics, London.
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Festoons are areas of fullness, swelling and/or laxity located around the lower eyelid and upper cheek. They are sometimes called malar bags or malar mounds.
Traditional eye bags are usually associated with changes around the lower eyelid and orbital fat. Festoons occur lower down, around the malar or upper cheek region, and can involve fluid accumulation and soft-tissue laxity.
Botulinum toxin is not a universal treatment for festoons. Whether it has a role depends on the underlying anatomy and the muscles involved. A consultation is required before deciding whether it is appropriate.
Festoons should not automatically be treated with dermal filler. Adding volume to an already prominent or swollen malar area may worsen the appearance in some patients. Assessment is therefore essential.
Some mild to moderate festoons may respond to non-surgical treatments, particularly where skin laxity is an important component. However, more pronounced or structurally established festoons may require surgical assessment.
Radiofrequency microneedling is one of the non-surgical technologies that has been investigated for festoons. Recent research has reported improvement in mild to moderate cases, although results vary and further evidence is needed.
Ageing is an important contributing factor, but festoons are multifactorial. Genetics, facial anatomy, skin quality, tissue laxity and fluid accumulation can all play a role.
Yes. Because festoons can involve ongoing age-related changes, tissue laxity and fluid accumulation, treatment cannot necessarily prevent future changes. Long-term management should therefore focus on the underlying anatomy and skin quality.
Not necessarily. Festoons and tear troughs are different concerns, and adding filler to the wrong area can potentially make malar swelling more noticeable. An expert assessment should come before any treatment.
At SAS Aesthetics, we look at the relationship between the eyes, cheek, skin and facial structure before deciding what — if anything — should be treated.
Book a consultation with Dr Mahsa Saleki
London | Doctor-led aesthetic medicine | Natural, considered results
We have a bespoke treatment option that works by closing the festoon over a period of 3 months. This treatment uses an in house protocol developed by Dr. Mahsa Saleki and is a one of a kind treatment. It utilises laser technology to adhere the walls of the festoon sac together whilst simultaneously banishing the retained fluid in the skin.
As your cosmetic surgeon I have trained tirelessly over the last decade with your safety and results in mind. I’ve developed a real knack for innovating unique techniques that promise natural but meaningful results. I’m genuinely excited by the advances in surgery and aesthetic medicine and can’t wait to offer them to you as my patients.
Dr Temi is a highly skilled medical professional with a deep passion for skin health and holistic patient care. She is dedicated to helping patients feel confident in their skin through personalised and results-driven treatment plans.
I’m here to help you experience a seamless journey with us With over 10 years experience working in Londons’ best clinics I can help you maximise your treatment plan with the confidence that you have someone always at hand to help you.
Dr Saleki is the sweetest and most professional Dr ever! I was really nervous and she completely put me at ease for my fox eye thread lift!
I was a bit nervous, Dr Mahsa was lovely, she couldn’t of been more professional and kind. I had nose threads and the procedure was quick and apart from a bit of discomfort with the anaesthetic, the rest was totally pain free. I am 3 days post treatment and still a bit swollen but other than that everything has been very smooth and I feel fine. I’m excited to see the settled results. Would I recommend, 100% yes.
First time I every had any treatment and it was a brilliant experience, The Dr was very Calm and compassionate and clear. I read about a treatment threading but she said I didn’t need it and suggested fillers and fat dissolving which has work for me, definitely go again even though it took me over 2hours to get there.
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Surface changes and structural changes can look identical from the outside. They need completely different solutions. If your routine has stopped working, it might not be a product problem. Book a consultation to know what you`re dealing with.Link in bio. #sasaesthetic #nonsurgicallift #skintightening #facialrejuvenation #aesthetictreatments
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I treat skin every single day. Here is what I wish more women knew before they came to see me.1. The biggest change in your skin after 35 is not at the surface. It is structural. The products on your shelf can support it ,but they cannot rebuild it.2. Most women I see are doing too much. Layering actives that cancel each other out, stripping a barrier that is already struggling. 3. SPF is the most powerful anti-ageing tool you have. Wear it every single day and reapply throughout the day.4. You cannot out-product a poor lifestyle. Sleep, nutrition and movement do more for your skin than anything you can buy.5. Your neck and chest are ageing faster than your face, and most people completely ignore them. Start treating them now.6. Price is not a marker of efficiency. Some of the most clinically proven ingredients cost almost nothing. Most of what you are paying for is marketing.7. Strong actives are not always better. Most skin issues I see come from overuse, not underuse. If something is irritating your skin, it is damaging your barrier.8. Your skin at 40 does not need the same routine it needed at 25. Most people are following advice built for someone half their age.9. A bad previous treatment is harder to fix than doing nothing at all. Choose your practitioner well before you choose your treatment.If you want to know where to start with your skin treatments, a consultation is the best first step. Link in bio. #sasaesthetic #nonsurgicallift #skintightening #facialrejuvenation #aesthetictreatments
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The treatments celebrities reference are rarely as mysterious as they suggest. Sofwave, polynucleotides, skin boosters, collagen stimulators… that’s the stack.Curious what`s right for you? Book a consultation using the link in bio. #sasaesthetics #aestheticmedicine #naturalresults #facialrejuvenation #skincarejourney
Most people associate CO2 laser with one thing. The reality is it covers a lot more. Acne scarring, fine lines, uneven texture, sun damage. Often in the same treatment. But, it isn`t right for everyone. A consultation is where you find out if it`s the right fit. Link in bio to book one today. #co2laser #laserskinresurfacing #acnescars #skinrejuvenation #aestheticmedicine
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