Can I do anything to fix the "malar bags"? (photos)

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.

This is a specific anatomic issue and is often not well recognized.  Malar means "cheek" and so these are literally the "bags" that are on the cheekbones.  Those are different from the usual "eye bags," which are fullness of the fat underneath the eye(ball) itself.Malar bags or pouches can be troublesome; they are visible and hard to treat, which is an unfortunate combination.  (They can actually get worse temporarily during and after treatment of other regions around the eye, such as the eye bags, tear trough deformity, etc).  Many different things have been tried, including liposuction (since it's not fat they, understandably, don't respond well to that), laser, peels, etc.  I am not aware of consistently effective and safe treatments of malar bags at present.You should see several board-certified plastic surgeons for an in person consultation to see what the options might be for an improvement in the region overall, even if not specifically for the malar bags.I hope that this helps and good luck,Dr. Alan EnglerMember of #RealSelf100@RealSelf