Condition: Malar bags, jowls and midface descent 2017-10-12T10:20:05+00:00

Malar bags, jowls and midface descent Overview

Talk to us about your current condition on:
020 7935 7990

The best way to figure out whether your specific condition can be treated or not is to give us a call. We can answer any questions you have and help you clarify which treatment options might be suitable for you.

There are different treatment options available for this condition and the most common ones are listed below:

  • Filler (hyaluronic acid gel – eg. Restylane® – or autologous fat transfer)

  • Lower lid blepharoplasty with fat repositioning

  • Malar bags/festoons: Direct excision

  • Mid-face ptosis: Mid-face lift

  • Jowls: Face lift

Learn more about treatment options

Malar bags, jowls and midface descent

What are malar bags, jowls and midface descents?

With ageing the upper cheeks lose fat, sag and the mid-face drops (mid-face ptosis). Hollowness below the eyes with evident tear troughs may develop, which can be very evident. Tear troughs are usually treated with filler and can be aided by blepharoplasty or a mid-face lift.

Types of midface descent

However, there is a type of mid-face descent with an excess of skin and fluid which are known as

  • Malar bags
  • Festoons

The term ‘jowls’ refers to lower face jawline sagging when the mid-face and the lower face has dropped and is usually treated surgically with a face lift.

Patients can have a combination of tear trough hollows, mid-face ptosis, malar bags/festoon and jowls. Hence the treatment for each patient is specific and varies but may include filler, blepharoplasty, mid-face lift and face lift (or a combination of these).

N.B. At Clinica London we administer filler, perform blepharoplasty and excise malar bags and festoons. We do not however, perform face lifts ourselves, but will work closely with plastic surgery colleagues if required.

Video: Can you treat eye bags or malar bags?


A full periorbital examination is carried out by the oculoplastic surgeon. This includes examination of the eye surface, the tear film, eyelid laxity testing, eyelid and cheek measurements. It is useful if you bring along photographs from a younger age to the initail consultation. The oculoplastic surgeon will take photographs during the assessment both as a clinical record and for comparison should you wish to continue on to treatment.

In particular the oculoplatic surgeon will be assessing what proportion of the problem is due to tear trough hollows, malar bags/festoons, mid-face ptosis and jowls in order to plan the bespoke treatment.

More about the different types of mid-face descent

Malar bags or festoons

These cannot be treated with filler but require surgery.

Treatment for malar bags, mid-face ptosis and jowls

Often a combination of procedures is required such to treat these different conditions:

The most common treatment for malar bags/festoons at the junction of the lower lid and upper cheek is direct excision. The operation is performed under local anaesthetic, often with sedation. Stitches are used to close the wound which will be removed up to two weeks later. Patients who also require a mid-face lift have their surgery done under general anaesthetic. This is usually performed as a day case procedure, so you will not require an overnight stay.

What our patients say

“Dr Jane Olver was fantastic! She was so caring and sweet and it was clear that she knew what she was doing – very professional! I am absolutely over the moon with my results now!”
“If you have a similar problem, Jane Olver is your woman – I wish I had found her at the start. I will be forever grateful for her care and expertise.”
Nancy W.
“Just wanted to thank you for your exceptional assistance with my eye condition. I was so worried but you really helped me feel at ease.”
David T.
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Julia S.
“Just a quick note for saying thanks for looking after my Mum so wonderfully as she was very worried about the appointment and you really made such a big difference to the experience.”
Sven K.
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Mariah P.
“From the moment I met her to the moment I left, I was treated with great courtesy and kindness, and everything was explained to me in layman’s terms so I could fully understand my condition. I was immensely impressed.”
“Many thanks to Mr Khan. His prompt diagnosis and explanation was very reassuring indeed.”
Heather M.
“Just keep up the good work Dr Khan. My wife, who accompanied me, and I were both very impressed by the care and consideration shown by the whole team when I had surgery. I just hope they haven’t lost the knack by the time I get my other eye fixed. joking apart the care of this team has made it a wonderful experience for me.”
David S.
“Dearest Brian, Merry Christmas and a Happy New Year! Competent, sensitive doctors like you are the prize of the medical profession! I am so grateful that my experience was so positive. Love you Olga from Estonia”
“Dear Mr. Leatherbarrow and the Staff at Clinica London, Just a little not to say thank you very much for the great work you did to my eyes and the treatment I received. I am delighted with the results. Kind regards, Alexia M.”
Alexia M.
“Dear Professor Michel Michaelides , Thank you very much for your letter of the 4th September 2012. Ths means so very much to myself and Victor, during this terrible stressful time. Ever sind my first consultation with you, the caring dedication and understanding I have received from you has been priceless. Thank you with all my heart. Wishing you a healthy and happy future. Yours sincerely Doreen S.”
Doreen S.
“Dear Dr. Michaelides, I just wanted to express mine and my parents gratitude for arranging to see us all today and taking the time to answer all our questions. We left with a much greater understanding of the issues involved with genetic testing, the potential pattern of inheritance I have, and a renewed optimism over advances that could be happening in the field. It was also very helpful and reassuring to see Dr Amar again and be introduced to Jonathan the genetic counsellor – please do pass on our thanks to them as well. Yours sincerely Rachael S.”
Rachael S.
“Dear Professor Michaelides ,
Well done and thank you! You saw me last November for my annual RP assessment. You recommended to see the Glaucoma unit which I duly attended last week. (There was a delay because I had a cataract op in February)I do indeed have glaucoma as well as RP. Thankfully glaucoma is likely to be treatable with drops, so now at last the deterioration in my sight may be least partially arrested. I hope you will recommend to the retinal team that all RP suffers are tested for Glaucoma at fitting intervals. Yours sincerely, Edmund S.”
Edmund S.
“Dear Professor Michaelides ,
On behalf of my mother as well as myself, I would like to thank you for the consultation we had with you last Friday regarding my Usher Type 2/ RP condition. The knowledge and advice you shared with us was much appreciated. Today I received copy of the letter which you sent to my GP as record of the consultation. You might recall I mentioned that I have and indoor cycling frame which is great for an ex-road cyclist. If you should have any other patients who have to give up cycling on the road, I can recommend the “e-motion rollers” which is an American product and allows cyclists to ride their actual bike without modifications – suitable only for road bikes with high tyre pressure. Kind regards, Chris B.”
Chris B.
“Thank you for this, it’s nice to know you got the information you needed and were treated with respect. The team at Clinica London are good and the key thing, as you say, is seeing someone with the speciality in retinal degeneration. David “
“Dear Michel, My wife and I wish to thank you for your kindness and attention with regard to my poor eyesight. Your caring attitude and honest approach to help relieve my problem and find the best solution is overwhelming. And it is with this in mind we would like to express our sincere thanks for everything you have done for me. Kind regards, Maurice K”
Maurice K.
“Mr. Reddy was extremely kind and his special ‘duck’ noises certainly helped catch Talia’s attention and helped his examination run smoothly. Mr. Reddy informed us that Talia’s squint was severe and that glasses would not help her. He explained that she would need surgery. We have recently seen Mr. Reddy and the Orthoptist for a follow up and everyone involved is really pleased with the results of the surgery, most of all it seems is Talia.”
Rebecca and Daniel Corney
“What I loved most was her willingness to take my knowledge of my disease and experience into consideration. I am very impressed and feel lucky to be in her care.”
Fiona M.
“Dr Crawley is always in such a good mood and always does her utmost to help. Best doctor I have ever seen!”
Matthew K.
“Dr Crawley has a wonderful manner, is clearly knowledgeable and is an asset to the hospital.”
Lisa A.
“Thank you for forwarding the medical report. Please convey my thanks to Jane, I was deeply impressed by the politeness and empathy shown to me. I found the surgery very peaceful and beautifully decorated and I hope to see Jane again soon.”
Jeffrey W.
“Dear Jane,
I just wanted to say thank you for seeing me at such short notice. I felt much better after speaking to you and being reassured. I am much calmer and actually got some sleep last night.
I would also like to thank Ingrid, who was so lovely and very professional.
Best wishes, Catherine M.”
Catherine M.
“Thank you for forwarding the medical report. Please convey my thanks to Jane, I was deeply impressed by the politeness and empathy shown to me. I found the surgery very peaceful and beautifully decorated and I hope to see Jane again soon. Jeffrey W.”
Jeffrey W.
“I highly recommend Jane Olver. The whole experience was calm,and highly professional..”
Lorraine M.

“Dear Both,

Many thanks for taking care of my ptosis surgery today.
I am now back home and resting but wanted to send a quick note to thank you for taking such good care of me.

Many thanks, Charmaine”


The Highest Quality

We are accredited with the major private health and professional specialty bodies who have bestowed upon us the qualifications to carry out aesthetic and medical treatments at the highest levels of quality.

Frequently Asked Questions

Malar bags:
Most patients say they feel little or no pain during surgery. Although you will be aware of some sensations such as pressure, these should not be uncomfortable. We will give you an injection of local anaesthetic in the brow and lower-forehead to numb the area. This injection can sting a little, but we will give you some medicine to make you drowsy before we do this.

Mid-face lift:
This is a more invasive surgery so there will be more discomfort after the operation. You may feel a slight ache and tension in the area for a few weeks. Painkillers such as paracetamol or ibuprofen will settle this.

Depending on the type of your operation you will have a pad placed over the area at the end of the operation. This will stay on until the next day. When you take the pad off there may be some bruising and bleeding. Ice packs will help reduce this. Cover the area with clean gauze, apply an ice pack for 30 minutes followed by a 30 minute break, then repeat. This should be done continuously during the first 48 hours following surgery whilst awake. Sleeping with extra pillows to raise the head also helps reduce bruising and swelling.

You will be given an antibiotic ointment to apply to the wound 3 times a day. If you feel any pain, painkillers such as paracetamol or ibuprofen may be taken. Do not exceed the maximum dose. After a mid-face lift you may also be given antibiotic tablets 1 week. Avoid swimming for at least 2 weeks after the operation.

Malar bag excision:
Initially the area is swollen. The face is an area that heals relatively quickly. The swelling and bruising can disappear in 2-3 weeks.

Mid-face lift:
You may feel some discomfort, mainly tension in your face (as the tissues have been pulled upwards). This takes longer to heal, usually a few months before final result is achieved.
The scars will fade gradually, but in any case tend to be hidden within hair or natural wrinkles.

This depends on the nature of your work. There may be bruising and swelling after surgery and some discomfort. Avoid strenuous activity, heavy lifting and swimming for at least two weeks after surgery.

You should not drive or operate machinery for 48 hours after a general anaesthetic and 24 hours after intravenous sedation.

Normally, you will be reviewed 1-2 weeks after your operation. As the wound is under tension we prefer to leave the stitches in for at least 10 days. Sometimes we remove the stitches in two stages, during separate appointments, rather than all at once.

As with any operation there is a small risk of complication. Serious complications such as infection or significant bleeding are extremely rare. We will aim to achieve perfect symmetry between the two sides, but sometimes this is not possible.

Occasionally more than one operation is necessary to achieve the best result.