Malar mounds, also known as festoons, are a common, yet often frustrating, cosmetic concern. These soft, crescent-shaped pouches appear on the upper cheek, just below the lower eyelid, and can give the appearance of constant fatigue or swelling.
They can be challenging to treat, but a multi-faceted non-surgical approach can help. Surgery appears to be the most effective treatment at the moment. Radiofrequency microneedling seems to be the current gold standard from the non surgical perspective, but certain risks have been recognised by the Food and Drugs Administration (FDA) in the United States.
It is important to have realistic expectations about this, so this clinic cannot claim to specifically treat malar mounds, but it can help with improving overall skin quality in the area and improving the facial appearance overall with a natural look. This clinic offers a combination of approaches that can help to improve the firmness and texture of skin over the mound, which visibly reduces its prominence.
What Exactly Are Malar Mounds (Festoons)?
Unlike typical under-eye bags, which are often caused by bulging fat, malar mounds are more commonly linked to:
- Fluid retention (Malar Oedema)
- Loss of skin elasticity and weakening of the supporting muscle (Orbicularis Oculi) due to aging and sun damage.
- Genetics and certain lifestyle factors (like diet and smoking).
Because they involve both tissue laxity and fluid, a combined approach is often the most effective path to a smoother, more refreshed look.
This clinic selects procedures with a focus on regenerative aesthetics with a natural emphasis, stimulating the cells to work better. The approach would be to stimulate collagen.
A course of Polynucleotide injections would help with priming the skin for the procedures which follow next. If the cannula technique in the mid face is used to improve the skin quality, the number of needle insertions is minimised and so there is very little downtime.
A medium depth peel such as a Vi Peel could be part of a treatment plan, but could not be expected to be effective as a standalone treatment. The role of the peel would be to help with skin texture and collagen induction. As with all peels, a series of peels would be needed. The VI Peel uses a synergistic blend of acids, often including Trichloroacetic Acid (TCA), which is the key ingredient that gives it its medium-depth classification. The benefits for the malar mound area are primarily related to collagen induction and skin tightening:
- Texture and Pigmentation: It effectively addresses secondary issues like sun damage, fine lines, and uneven texture (which often make the mounds look worse), leading to an overall smoother, rejuvenated periorbital area.
- Collagen Contraction: The medium-depth peel causes a controlled injury to the epidermis and the upper layers of the dermis. As the skin heals and regenerates, this process dramatically stimulates new collagen and elastin production.
- Surface Tightening: This surge of collagen creates a noticeable tightening and firming of the skin overlying the mound. By improving the quality and elasticity of the skin, the peel can reduce the crinkly, lax appearance often associated with festoons.
What about a skin booster such as Sunekos?
There is potential for this to be useful as an injectable treatment for malar mounds because of its unique mechanism of action.
Sunekos is an injectable skin booster, but it differs significantly from traditional dermal fillers. It is a patented formula combining non-cross-linked Hyaluronic Acid (HA) with a specific cluster of six Amino Acids (the building blocks of collagen and elastin).
This combination makes it uniquely suited to address the components of malar mounds:
1. Structural Biogenesis and Lifting
- Mechanism: Sunekos works by stimulating the skin’s fibroblasts to produce new, fresh Collagen (specifically types III and IV) and Elastin. This process is known as Dermal Biogenesis (natural regeneration of dermal tissue).
- Benefit for Mounds: Malar mounds are caused by weakened, lax skin structure. By injecting the ingredients directly into the dermis of the upper cheek/under-eye area, Sunekos rebuilds the Extracellular Matrix (ECM). This action thickens and firms the skin, creating a subtle, natural lifting and tightening effect that helps restore elasticity and smooth the contour over the mound.
2. Hydration Without Bulk (Crucial for Festoons)
- Mechanism: The Hyaluronic Acid component provides deep hydration, but because it is non-cross-linked, it does not attract the same level of water or provide the structural volumisation that a traditional filler does.
- Benefit for Mounds: This is a key advantage. Traditional fillers can sometimes worsen malar mounds by adding bulk that attracts fluid, making the swelling worse. Sunekos provides hydration and structure without this risk of creating excess volume or puffiness.
3. Addressing the Delicate Under-Eye Area
- Sunekos is specifically effective in the periocular area (around the eye), where the skin is thin and delicate. It is often used to treat under-eye bags, dark circles, and thin, crepey skin. Because it regenerates the skin from within, it improves the overall quality and resilience of the skin directly adjacent to and over the festoon
However, it’s crucial to have realistic expectations: since this does not include Radiofrequency (RF) energy, it won’t offer the deep, structural tightening that RF microneedling can provide.
Combining automated Microneedling (Dermaroller XCellaris ProTwist), Zo Skin Health Peel and Firming serum accelerated
Automated microneedling with Dermaroller XCellaris ProTwist combined with a Zo Skin Health Peel and accelerator serum could help – but it will not offer the deep structural tightening that radiofrequency microneedling would offer.
This combination could help improve the appearance and severity of mild to moderate malar mounds by tackling the key factors of skin laxity and collagen degradation.
However, it’s crucial to have realistic expectations: since this does not include Radiofrequency (RF) energy, it won’t offer the deep, structural tightening that RF microneedling can provide.
- Mechanism: Automated microneedling creates thousands of tiny, controlled micro-injuries in the skin. The XCellaris ProTwist, being a high-quality device, is designed for precise, non-traumatic penetration up to depths of 2.5mm or more.
- Benefit for Mounds:
- Collagen & Elastin: This process forces the skin to enter a healing cascade, resulting in the production of significant amounts of new collagen and elastin in the dermis. This thickens and firms the skin overlying the malar mound, which can make the pouch look less prominent and crêpey.
- Product Absorption: The micro-channels created allow for superior absorption of any topical product applied during or immediately after, enhancing the effects of the Firming Serum.
- Limitation: It is still primarily a skin treatment. It cannot tighten the deep underlying supportive ligaments and muscle layer (Orbicularis Oculi) as effectively as a thermal treatment like RF microneedling.
ZO Skin Health Stimulator Peel for Exfoliation, Surface Tightening, and Product Penetration
- Mechanism: The Stimulator Peel is a superficial peel (often referred to as a “lunchtime peel”) utilizing a blend of Alpha and Beta Hydroxy Acids (Glycolic, Lactic, Citric, Salicylic).
- Benefit for Mounds:
- Cell Turnover: It encourages rapid cell turnover, improving skin quality, smoothness, and radiance.
- Mild Tightening: While superficial, regular peeling over time contributes to healthier, more compact collagen in the upper dermis, which provides a mild tightening effect on the skin’s surface.
- Synergy with Microneedling: By removing dead, dull skin cells, the peel primes the tissue to better respond to the microneedling procedure and enhances the overall result.
The Role of Zo Skin Health Firming Serum Accelerated : Structural Support and Sustained Firmness
- Mechanism: This serum is formulated with ingredients like ZCORE™ complex, which supports the dermal-epidermal junction (the structure that anchors the skin’s layers together) and promotes the visible improvement of skin elasticity and firmness.
- Benefit for Mounds: When applied following microneedling (when penetration is maximized), the active firming ingredients are delivered deeper into the skin’s structure, providing sustained daily support to counteract laxity and sagging.
What about the new Zo Skin Health Facial Refining Concentrate?
This could help to support in clinic procedures such a RF microneedling. It is a high-end product, which is unusual amongst the Zo Skin Health portfolio as it can be used as a standalone treatment as well as within specific Zo Skin Health protocols for ageing. The ZO Skin Health Peptide Facial Refining Concentrate is primarily designed to address signs of aging related to laxity, volume loss, and expression lines, which makes it highly relevant to the core issues of malar mounds.
The effectiveness of this concentrate lies in its four cutting-edge peptide technologies and its ability to influence the structural integrity and volume of the skin—both of which are major contributing factors to festoons.
1. The “Refining Peptide Complex” and “Facial Geometry”
- Mechanism: This complex is specifically noted for supporting a visibly more refined facial geometry and improving the appearance of the skin’s structural integrity.
- Benefit for Mounds: Malar mounds distort the natural contour of the mid-face. By strengthening the skin’s structure and elasticity (which is the main job of collagen and elastin), this peptide complex works to provide a visible lifting and sculpting effect. This can help the skin hold tighter against the underlying tissue, subtly reducing the projection and pouch-like appearance of the mound.
2. The “Volumizing Tripeptide”
- Mechanism: This tripeptide supports the skin’s natural production of Hyaluronic Acid (HA) for a fuller, plumper-looking appearance.
- Benefit for Mounds: While you don’t want the mound itself to be fuller, you often find hollowing or loss of volume around the mound (e.g., in the tear trough or below the mound) that makes the festoon appear more prominent due to shadowing. By restoring volume and enhancing hydration in the surrounding deficient areas, the concentrate can help create a smoother, more balanced transition across the mid-face, which could visually minimize the appearance of the mound.
3. Neuropeptides (Acetyl Octapeptide-3 & Acetyl Hexapeptide-8)
- Mechanism: These peptides work similarly to certain neuromodulators (like Botox) by modulating muscle contractions. They are focused on smoothing the appearance of dynamic and static wrinkles, especially around the delicate eye area.
- Benefit for Mounds: Festoons often occur due to the weakening of the orbicularis oculi muscle. While a topical peptide won’t fully immobilize the muscle, by relaxing some of the tension and movement in the surrounding skin and tissue, these peptides can help smooth out the fine lines and crepiness that often accompany malar mounds.
What about less expensive treatments?
As with the options above which are available from this clinic, the gold standard non-surgical treatment appears to be radiofrequency microneedling. This clinic offers options to support skin quality before or after investing in those treatments.
The WOW Fusion treatment is a sophisticated, low-downtime option that delivers superior skin quality, firmness, and texture compared to standard microneedling. It is an excellent choice for mild to moderate malar mounds or as a maintenance treatment after deeper therapy.
WOW Fusion is an excellent skin-boosting treatment that uses highly customized nutrients and collagen stimulation to smooth and tighten the skin, making it a fantastic, lower-intensity option for festoons, especially when micro-toxin is included in the bespoke cocktail (which is also helpful for those experiencing facial redness).
Malar mounds are difficult to treat. The most effective non-surgical intervention appears to be radiofrequency microneedling (which is not offered by this clinic). However if you are looking to prepare your skin for that procedure, or are looking to support the results afterwards then please book a consultation to talk through which approach could work for you. The first consultation always takes place on the phone/Zoom/Google meet, and the first appointment in clinic is redeemable against products or procedures of a greater value purchased on the same day.
