This Article Has Been Medically Approved By

Dr. George H. Sanders

Many a patient has come to me asking how they can rid themselves of areas of swelling over their cheekbones which are called “Malar Bags.” Sometimes these may seem to drop down from the lower eyelids, but taking away lower eyelid fat does not cure them.

What Are the Causes of Malar Bags?

There is no one specific cause of malar bags or festoons. There can be several contributing factors that range from genetics to diet to aging. The causes can differ from one person to the next, making it even more important to consult with your doctor to determine which treatment option is best for you. Some common causes include:


Genetics that make you more susceptible to fatty deposits or weak muscles around the undereye area.

Loss of fat around the cheekbones that can cause sagging and make malar bags appear more pronounced.

Fluid retention in the compartment below the eye. Limiting salt intake may help reduce fluid retention and swelling.

Skin laxity that allows areas around the eye and cheeks to become puffy and swollen.

Sun exposure can damage the skin and contribute to puffiness.

Smoking can break down essential collagen and weaken skin structures which may emphasize the appearance of malar bags.

Deep creases that form and trap fat deposits or fluid retention above them creating the appearance of an under eye bag.

Skin changes due to aging that can result in shifting of fat pads and fluid, thinning of the skin, and other structural changes that contribute to malar bags.

Before and After Photos

Patient 9a Eyelid Surgery Before and After
View Our Eyelid Surgery Gallery

How Can These Malar Bags Be Treated?

Non-Surgical Treatments

There are several non-surgical options for reducing the appearance of malar bags and tightening the skin around the eyes and across the upper cheeks. Not every patient is a good candidate for every procedure. Dr. Sanders will recommend a treatment plan based on your individual situation and goals.


Fillers can add additional volume around the cheekbones to smooth out the skin and create a more even appearance. They can enhance the natural curves of the face and fill in any sunken areas. In addition, they can reduce the appearance of fine lines that can amplify malar bags.
Learn More

Laser Skin Resurfacing

Laser resurfacing may help to tighten the skin beneath the eyes, and also stimulate natural collagen production. This may help reduce the appearance of fluid retention and skin laxity by encouraging cell turnover to generate healthier, firmer, younger-looking skin. There is minimal downtime following treatment.
Learn More

Chemical Peels

Chemical peels are an effective way of promoting new, healthy skin cells and removing old cells. They can help eliminate fine lines, wrinkles, creases, and damage while encouraging tighter, firmer skin. This may reduce the appearance of malar bags and improve contour without the need for surgery.

Surgical Treatments

In some cases, surgical treatment could lead to more noticeable and effective changes than non-surgical options for malar bags. With surgery, the doctor will strategically place incisions so that they blend in with natural creases and features of the skin as much as possible to minimize scarring.


Blepharoplasty or eyelid surgery can remove excess skin and fat deposits to smooth the contour of your lower lid and upper cheek area. It can help to tighten skin and reposition fat pads in order to create more aesthetically pleasing curves and enhance the appearance of your eyes.
Learn More


A facelift can gently tighten skin and reduce sagging to help minimize the appearance of bags under the eyes. A cheek lift can be part of your facelift to target affected areas and remove excess skin while redistributing fat pockets, creating an overall more youthful appearance.
Learn More

Further research is needed, however, if we are to cure the problem of malar bags. In the meantime the measures listed above may help. Please contact my Los Angeles Plastic Surgery Clinic for further information or to schedule your consultation.

Should you have further questions, please feel free to contact my office.

George Sanders, M.D.

LA Breast Reduction Expert – Dr. George Sanders