The following is true in relation to ‘malar bags’ or festoons:
A. Interestingly, they are hardly ever seen in smokersThere is no accepted and routinely successful treatment. Prominence of tissue and skin folds can occur in the malar region with ageing, but in some patients these may present as proliferative skin folds. Lower lid blepharoplasty will not help this condition, which is commoner in smokers. Direct excision is rarely satisfactory and leaves unsightly scars in prominent areas. One approach that can help is subcutaneous dissection and redraping combined with a subperiosteal cheek lift.
References:
1. McCord CD, Codner MA. Eyelid and periorbital surgery. St Louis, USA: Quality Medical Publishing Inc., 2008.