Recommendations for doctors who will perform a malar bag excision? (Photo)

Question

I have a prominent malar bag on the right side of my face. It's so bad that I often get asked if I was punched in the face because it is so puffy. I want to have it excised. I've tried fillers which don't work to camouflage it because it's too big. I've tried lasers and they did nothing. I don't care about the scar, I want this festoon removed. I cannot find any surgeons who actually perform this procedure. I am looking for a surgeon to perform the excision and I will travel anywhere in the U.S.

Kenneth D. Steinsapir, MD · Answer

You posted two years ago a photo that demonstrated a lump at the bottom of the area that now is a malar festoon.  You indicate that you have had fillers to "camouflage" the area.  You should care about making a scar.  It is essential to not be further harmed in resolving this issue.  In an earlier post you indicated that you might have silicone oil placed into the cheek.  Did you do that?  That enormously complicates this.  If you were my patient, I would first remove all of the previous placed dissolvable fillers to assess what is going on in the cheek.  There are many options, including direct excision of the volume created by the graft fat which is the original cause of your issue.  Less is more.  Don't destroy your face because you made the mistake of being talked into a fat grafting surgery for the lower eyelid area.  Get real help.  Seek more than one opinion in this process.

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Camille Cash, MD · Answer

As you pointed out, malar bags are difficult to treat.  Even direct excision doesn't always produce great results and leaves a scar.  There are many types of lasers on the market and technology improves continuously.  I encourage you explore different options before deciding on surgical removal.

John R. Burroughs, MD · Answer

Malar bags can be difficult to treat if its important to you to avoid visible scars.  Oftentimes surgery is the answer, but there are other non-surgical treatments to include: RFAL (radio frequency skin tightening); Fraxel treatment to the area of swelling; tetracycline injections; fillers; and others.  If you haven't tried RFAL, which is a treatment below the skin surface then I would consider that.  It has shown moderate to great success with my patients and has little scarring risk as compared to surgery.  I will excise when necessary, but with your smooth cheeks and youthful skin I would not advise it.  Best regards.

Juris Bunkis, MD, FACS - Account Suspended · Answer

Malar bags are not easy to treat.    The only time I would do a direct excision on the cheek would be on an older person with a lot of wrinkles.    On you, a very prominent scar would be noticeable.   I have treated malar pads successfully under the skin, on patients whose cheek skin has been elevated for a facelift, but you look too young for that.   Are you sure some of the puffiness isn't from the filler?   The skin over the bag has a blueish hue that we sometimes see when Juvederm has been injected - if so, do not inject anything further and let things settle.

Recommendations for doctors who will perform a malar bag excision? (Photo)

Answers (5)

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