Treatment for Malar Bags
Malar bags have confounded plastic surgeons and patients for years, and there is no perfect solution. Indeed, there isn't even a consensus about the underlying cause. So it is best to try to treat the visible signs of malar bags(discrete puffiness over the cheekbone area just below the eyelid). Sometimes performing a lower eyelid blepharoplasty/lift will elevate and firm up this area, decreasing the puffiness. Even when performing a facelift and lifting the cheek fat pad, I have seen some improvement. However, if you are young and your skin is reasonably firm as your photos seem to show, then I would try using fillers or your own fat in the area surrounding the bags to smooth out the overall contour. Microfat grafting would need to be done very conservatively but has the potential to be longlasting. You might also consider a non-invasive technology such as a laser treatment or a chemical peel of the skin over the bag in order to tighten the skin, therebye pressing down on the bag and flattening it somewhat. Other less successful treatments that have been tried in the past include very fine liposuction of the bag and actual direct excision of skin and fat, but that would leave a visible scar.
Looking at your photos you really have a minimal asmount of aging showing.I would consider a very conservative bleph and perhaps some judicious fat grafting to the area.
You need a combination of two things. You need a blepharoplasty with some lateral suspension of the obicularis muscle and you also need a small amount of filler to fine tune the view you are showing in the photos. I would also add here that the problem shown in the photos is not severe and if you chose to do only a small amount of filler or nothing at present it would be a very sensible decision I would not fault you for.
Bleph for malar bags
Thank you for the pictures. They are the best shot to give a true evaluation. I can see I would not recommend any treatment. The best answer will come from an in person consultation.
There are a couple of ways to help this.
You have laxity of the orbitomalar ligament. This creates a fullness above the mid cheek groove. It may be that you could have mid face filler and this can relieve this. Effects can last about a year and the treatment, which should be done with Restylane can be adjusted if needed.
Chemical peels can also iron out this issue.
Finally, lower eyelid surgery will address this. However you need to have the orbicularis oculi muscle resuspended separately from the skin. This is essentially a mid face procedure. Here is the rub. You need to find a surgeon who is really doing these types of surgery ( as opposed to telling you that they do these all the time).
Start with a consultation. Consider the non-surgical treatments first. Proceed with caution.
A standard blepharoplasty will not correct malar bags.
A specific type of blepharoplasty with orbicular pexy or muscle tightening of the lateral or side portion of the eyelid lower eyelid muscle can improve malar bags. However filler injections are a nice nonsurgical method which can also make a difference.
Orbito malar crease
The orbitomalar crease will typically require fillers or fat grafting to improve. A blepharoplasty will not address this unless dissection is performed down to the level of the crease. Any surgery will transiently worsen malar edema and even accentuate the crease so you have to be patient. You are young so I would recommend a filler or fat grafting for now and leave the blepharoplasty for later.
Best solution for you.
Excision or repositioning would not be a good option for you. Filling the depression will give a more aesthetic result. HA injectable fillers would give a nice result but typically last a year at most. Fat transfer into that area will provide results lasting decade(s). Always remember no treatment prevents aging.
Will a Blepharoplasty fix my malar bags? I'm just wanting to have the fat and / or muscle re-positioned.
I would not recommend a blepharoplasty. I might try HA filler in the depressed area, like BELOTERO-Balance...