I am 4 weeks post op lower blepharoplasty. Is the puffiness under my eyes swelling or malar bags? (Photo)

Festoons are swelling of the malar fat pads.  It is not uncommon for the swelling after a lower lid surgery to move down to this area so that it will make the malar pads look worse.  The prolapsed fat pad area looks better.  This will slowly resolve.  I usually have patients use warm compresses and do some gentle massage  up and out over the swollen area.  It is frustrating to see this but it will improve!   

Without seeing photos of you before surgery, it is difficult to tell. If you did not have festoons in the cheek before surgery, they probably would not be caused by the lower lid blepharoplasty. Lower eyelid surgery causes the lower eyelids and cheeks to be swollen for some time. Give yourself at least another 4 weeks for that to resolve. Be sure and follow up regularly with your surgeon.

Thank you for posting your pictures. I am sorry you are not happy with the results. I understand your concerns. Perhaps some of it might be related to post-operative swelling. Another important point to address is that your malar fat pat is ptotic, which accentuates the lid-cheek groove giving the malar festoons a more noticeable appearance. What I have recommended in the past in similar situation is to wait another 4 weeks, using warm compresses and gentle massage of the area, and then consider LIFTING the malar fat pad (cheek) by injecting Voluma XC, which is an HA filler. If this improves the results, then you can consider having a surgical lift of your cheeks with re-suspension of the orbicularis oculi muscle or fat grafting to attain a  long lasting result. Hope this was helpful and good luck!