Condition: Malar bags, jowls and midface descent2019-04-08T11:52:23+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.

“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!”

Toni C.

“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.

“I felt much better after speaking to you and being reassured. I am much calmer and actually got some sleep last night.”

Catherine M.
“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.
“I highly recommend Jane Olver. The whole experience was calm and highly professional.”
Lorraine M.
“I am writing to you to say thank you to you, Cloe and Jane for taking care of me this week. You were all really lovely and professional and I am very grateful. Big cheer for The Clinica London Team.”
Rick A.
“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.”

“The treatment was a great success; within 24 hours of starting the treatment the pain and swelling subsided and as a result, I was able to enjoy a great holiday in Argentina.”
“Thank you, my eye is recovering brilliantly (you almost can’t see I had it). Jane was amazing, please pass on a huge thank you.”


Recognised and trusted as a premium eye care and skin care specialist

We are accredited with the major private health and professional speciality 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.