55, male, can malar/festoons be treated nonsurgically and how? (Photos)

Lower festoons can be treated non-surgically using a CO2 laser. This can be done at the time of your lower blepharoplasty.

In my opinion, the festoons can be a significantly more difficult condition to treat than the lower eyelids. If the festoons do not bother you too much cosmetically, then it's fine to proceed with the lower eyelid surgery. If the festoons are a significant cosmetic concern, I would definitely hold off on having lower eyelid surgery alone, as this could complicate and worsen the appearance of the festoons. By all means, consider nonsurgical options such as radiofrequency treatments, and doxycycline injections. But I would recommend avoiding fillers and fat grafting as treatment for festoons as these could worsen the problem. Sometimes, surgical treatment is necessary and this often is combined with lower eyelid surgery. Good luck!

I have seen improvement in malar festoons in some patients using micro needling with radio frequency. I usually treat the area in 3 different sessions, spaced over time. There are a variety of micro needling devices that use radio frequency, but the one I use is Morpheus8.

At least from the photo provided, there appears to be significant midface volume deficit contributing to the flattening of the cheeks, deep smile folds and the bags and festoons under the eyes. Before jumping into expensive, invasive surgery and its attendant post-operative downtime, you may wish to explore the use of an appropriately robust HA volumizing filler for the midface. Since the upper cheek region is a major support for the under-eyes, filler revolumization of this region can not only help to contour and more youthful, less drawn and deflated face and diminish the deep smile folds, but can secondarily improve the under the eyes and help mask the bags and festoons. Treatment, in experienced hands should take no more than about fifteen minutes with immediate, on-the-spot results that typically engender a "Wow!" reaction. I personally find this one of the most gratifying treatments to perform. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

Festoons are notoriously difficult to treat. You may have improvement with Morpheus8 treatments. This will address overall skin tone and texture. The lower blepharoplasty will address the under eye bags.

Some people get nice results after having 3 sessions of radiofrequency microneedling. It can help with the puffiness, however the deep grooves between the lower eyelid and the cheek and along the cheek (palpebromalar and malar grooves) may persist. One of the most common and effective treatments to treat the grooves is fat grafting (requires harvesting fat). Another option is two to three sessions of platelet rich fibrin injection (requires a blood draw).
If the radiofrequency microneedling does not achieve the degree of improvement wanted, then a blepharoplasty surgery can address the fat pads under the eyes.