Cheek Dents Becoming More and More Pronounced?

Question

I've recently noticed the dents in my cheek becoming more and more pronounced and am wondering if any of you may know the cause of this. Could it be due to the fact that I sleep on my side? I though it may be a malar mound or something to do with the tear trough but to me they indents seem to be lower than those areas and also the lines aren't really slanted but more horizontal. Any advice and treatment options are appreciated!

Nelson Lee Novick, MD · Answer

Malar Bags, which may appear as "cheek dents," generally manifest toward the outside, upper portion of the cheek area. Multiple factors may contribute to their development, among them the natural volume deflation and sagging that comes with aging and drainage problems in the small lymphatic vessels in the region. Owing to the latter, anything that affects fluid dynamics, like allergic reactions, fatigue, excessive salt consumption, etc. may worsen the appearance.of malar bags.

	While malar bags are generally difficult to treat, I have found that superficial placement and molding of small amounts of Belotero Balance, a hyaluronic acid filler, along the "dent" helps to elevate line and permit a more natural, rounded contour. The benefit of Belotero is that even when superficially injected, as typically needs to be done for this situation, it does not result in the Tyndall effect, a bluish discoloration of the skin due to light scatter often seen with other hyaluronic acid-based fillers when injected too high up in the skin.

	Sometimes, the restoration of volume, using a volumizing filler, such as Juvederm Ultra Plus XC judiciously injected in a 3D Vectoring pattern on the sides of the eyes, helps to pull this area straighter lessening the appearance of the dents. To pre-assess the potential benefit of this approach, your physician may try pulling the skin upward and outward to see if there is improvement. If so, this technique alone, or in combination with the Belotero Balance directly into the dent, may give rise to gratifying aesthetic improvement.

Stephen Prendiville, MD · Answer

These areas you refer to as "cheek dents" are actually an anatomical finding known as malar bags. Malar bags sit at the top, lateral portion of the cheek and are distinct from eyelid skin. This finding is often worsened by fatigue, allergy, excess sodium intake, etc. Malar bags become more obvious with the aging process when descent/deflation of the cheeks occurs. Although there is no full-proof method of eliminating this change, sometimes deeper volume replacement is helpful (Sculptra), sometimes surgical elevation of the cheeks, and sometimes a combination of treatments provides benefit.

Toby Mayer, MD · Answer

Plastic surgeons do not like to see these since we do not have any really good treatment for these. Fillers conservatively done may be your best choice.

Steven J. Pearlman, MD, FACS · Answer

The biggest problems is that these bags often get larger and smaller since they are a collection of lymphatics that drains fluid from the areas. Lymphatics are very delicate vessels, like veins but thinner that collect fluid from areas of the body. Malar bags are very hard to treat since they are a "potential space" where fluid collects. There are numerous proposed treatments such as lasers, cautery, radiofrequency, injections etc. Unfortunately none of these can predictably get rid of the malar bags.

Michael I. Echavez, MD · Answer

Your are correct in that the dents on your cheeks are not related to your tear troughs. I'm not sure of the cause of the dents, but I have seen this before in other people. I would say the simplest form of treatment to try first would be using a filler to try and fill in the dents.

Darryl J. Blinski, MD · Answer

Easy temporary fix is HA fillers. As to cause there could be reasons as salt intake with swelling, formation of malar bags, weight gain, aging, etc.

William Portuese, MD · Answer

The pictures show malar bags which are of very difficult problem to deal with. Consideration for small cheek implants placed underneath the periosteum can be entertained to try to augment cheek area and flat out the cheek area and malar bag

Ritu Saini, MD - Account Suspended · Answer

Your cheek dents, known as malar bags can occur for a variety of reasons- volume loss attributable to aging or genetics, swelling as a result of allergies, or salt and lack of sleep. They can be improved with fillers, if properly placed.

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