Czy to malar bags, festoon, przepukliny? (Is it malar bags, festoon, hernias?) (Photos)

Question

Prosze o pomoc w kwalifikacji co to może być. Głownie po jednej stronie twarzy. Od paru lat. Nie zmienia się. Jakie zabiegi czy plastyka, czy laser, czy stymulatory, czy wypełniacze, czy tluszcz Please help me identify what this could be. It's mostly on one side of my face. It's been there for a few years now. It hasn't changed. What procedures should I try? Plastic surgery, laser, stimulators, fillers, or fat?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concern and photo — I completely understand how frustrating it can be to notice puffiness or swelling that persists, especially when it’s more prominent on one side of the face.

From your description, it sounds like this could be malar edema, festoons, or mild fat herniation (under-eye hernias). These conditions often appear as swelling or bulging in the area between the lower eyelid and upper cheek, and they can be caused by a combination of fluid retention, loss of skin elasticity, sun damage, or weakened supporting tissues with time.

Because it has been stable for a few years and hasn’t worsened, it’s likely not inflammatory, but rather structural or related to tissue laxity.

In terms of treatments:

Lasers (such as CO₂ or erbium resurfacing) can help tighten and smooth the skin, improving mild festoons.

Injectable treatments like skin boosters or dilute biostimulators (e.g., Sculptra, Radiesse) can help improve skin quality and firmness in that region.

Fillers can sometimes camouflage transitions but must be used carefully — overfilling can worsen puffiness.

Fat repositioning or lower blepharoplasty (a surgical approach) can offer the most definitive improvement when the issue is due to herniated fat pads or tissue descent.

A detailed in-person evaluation by a dermatologist or oculoplastic surgeon can help distinguish between festoons, edema, or fat herniation and tailor the best treatment plan for you.

Leonard Grossman, MD · Answer

Even though what is called a Malar Bag looks like one, it is the fact that the area closer to the nose in the cheek is lacking fat in volume. Generally an inherited condition from the father side. Usually it is seen even in a very young child. The best way to ameliorate the condition is with fat grafting to the hollow portion of the lower eyelid and cheek. In the right hands, the results are extremely natural and permanent. If you are to look at my website at facial rejuvenation with fat grafting, you will find that many people have that condition. Yet even years after having had the proper treatment, their faces look proportionate and consider considerably better. I hope this helps and good luck from Leonard Grossman, MD, organic Plastic Surgery, New York City.

Camille Cash, MD · Answer

From the submitted photos it appears the area that concerns you is related to malar bags.  These can occur for many different reasons including genetics and sun damage.  They are difficult to treat.  Some patients find improvement with lasers or Morpheus8.  I've included a video on this treatment that I hope you find helpful.

Czy to malar bags, festoon, przepukliny? (Is it malar bags, festoon, hernias?) (Photos)

Answers (3)

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