I have horrible puffy malars. Surely with all the new surgical techniques they can be removed? (photos)

Festoons represent an area of tissue that glides between two sets of ligaments.  Repairing these is complex and generally beyond the ability of most surgeons.  There are any number of ways to improve and resolve a festoon.  These areas can be helped with surgery, chemical peels, laser resurfacing and even fillers.  The MACS lift can be associate with less than normal vectors of facial stress and for that reason, I would urge the utmost caution in considering that type of surgery.

Malar bags can also be treated with a mild oral diuretic.  This helps the body to flush the extra fluids that it is holding onto.

Even today "puffy malars" remain an extremely difficult area of the face to treat. There are challenges related to anatomy that surgeons around the world are trying to find solutions for.  That said, you should see a board-certified, fellowship-trained Oculofacial Plastic Surgeon with expertise in cosmetic lower eyelid and cheek/mid-face surgery. Avoid entirely doctors who don't do this kind of surgery routinely. Please be realistic that perhaps you can be helped, but those "puffy malars" are not likely to disappear completely. Best of luck to you.
Damon B. Chandler, MD

Harvard-Penn Trained Oculofacial Plastic Surgeon

As discussed below, these are difficult to treat due to the anatomical considerations.  We've had very good responses in many patients with devices such as Ultherapy and ThermiRF .  Surgery is usually reserved for patients that won't improve with these other devices since it usually involves potentially creating prominent scars .  Thermi Rf is now my preferred treatment for malar bags in most patients but you need a thorough consultation to determine which treatment would be most effective in your case.Best of luck!