I hate my malar creases! Can I have filler to correct this problem? (Photo)

I really saw the malar creases in a recent photo I took. When I smile is when it really shows...and it depends on the light. I recently (2 months ago) had tear through fillers and I am very happy with the procedure. Also, it seemed like my malar creases were gone (tear trough injections swelling?)... I looked great! When the swelling went down...obviously they are back. What is the best procedure?

Doctor Answers 6

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately.
All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.

Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.


Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Malar crease

You are experiencing early descent of your cheeks creating a submalar crease as well as accentuated nasolabial depressions. You also have noticeable smile lines ("crow's feet").
The former will respond very well to fillers. There are choices and I would let the decision be made after appropriate consultations. The latter is treated by muscle attenuators such as Botox or Dysport. You should expect excellent results in the hands of an experienced injector.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

I hate my malar creases! Can I have filler to correct this problem?

Dear Funia15

You are absolutely correct that injectable fillers have revolutionized treatment of the midface over the past 10 years. While I used to perform midface lift procedures from 2002 to 2006, now most of those procedures are now replaced with fillers in the office with relative minimal cost and longevity of results.
Most often, fillers in the tear trough last more than 6 months and usually closer to 9 months. The cheek itself will last from 6 months to 1 year depending on type of filler used. The festoon area, (upper outer cheek) is a little different as it will itself look different day to day and more often fillers for that will only last 3-4 months as over-correction is a bad idea.
Look for experienced and properly trained surgeon certified by the American Board of Plastic Surgery.

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 49 reviews

Correcting MeloLabial Folds with Filler

Good Morning:

What you are experiencing is a natural progression in facial aging. You are first hand witnessing depletion and descent of the malar (cheek) fat pad, loss of the bony prominence of the cheek, as well as overall skin laxity. The natural result of these 3 forces working together is to emphasize the depth and appearance of the MeloLabial Folds to the left and right of your mouth and nose.

Lucky for you, you are living in one of the most exciting times for facial aesthetics, especially involving injectables. More and more products are being introduced on the market (Voluma, Restylane Lift, Perlane, Radiesse) which give experienced practitioners many options to use to address the changes you are seeing on your face. In addition, there is a greater exchange of information happening between practitioners involving advanced techniques, etc. all of which benefits patients.

How I would address your MLF's would emphasize recreating your natural cheek prominences, working with a filler in your midface zone. (This is a relatively new technique - last 5 years - for addressing MLF's) It is important to ask to see your practitioners examples of before and after, so that you don't achieve an overfull chipmunk look in the midface and that the result is natural looking. Adding volume and support in this zone decreases the depth, angularity and appearance of the MLF's around your mouth and nose. Most likely, I would use some of the product, or a different filler, to address and make small corrections in what remains of your MLF. Remember, most people in midlife still have MLF's, the difference between those of us who look depleted vs. those who are fresh, is often the depth of these folds. The goal should not be total obliteration of the appearance of these folds, as overfilling may contribute to an unnatural 'simian' appearance in the lower face.

I hope this information helps!


Steven Swengel, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

Malar Creases

Funia,
   Congratulations on getting your tear trough filled.  If you were happy with that with your injector then go back and share your current concerns.  Viewing your photos, it seems that either botox or additional fillers will all that you will need.  You are very beautiful and just a little more botox and/or filler would address your issues.  Thanks and Good Luck.

Paul E. Goco, MD
Nashville Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

I hate my malar creases! Can I have filler to correct this problem?

  Hi, based upon the attached photos the non-smiling photo is the best for evaluation of the face.  In that photo the cheeks are very flay anteriorly (in the front) and there is evidence of both nasolabial folds and jowls.  The cheeks can be augmented using a dermal filler (I prefer Perlane) or using cheek implants for a permenent correction.  Fat transfer, despite it's popularity remians unreliable and potentially problematic and as such I do not use this for augmenting and shaping the face.

 If you ever wish to further rejuvenate the face, jowls are sagging facial tissues and an indication for some form of a facelift, not Cheek Augmentation. I have performed many Cheek Augmentations over the past 25 years and the notion that Cheek Implants or dermal fillers to the cheeks will lift tissues is an urban myth. Filler to the cheeks or cheek implants will not lift up the jowls. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured. The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Perlane) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

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