Without photos, I can only comment in the most general of terms. Surgery is usually best for severe malar bags. However, less pronounced malar bags can often be successfully improved and camouflaged via the use of volumizing fillers. In my Upper East Side Manhattan practice I prefer to use Voluma XC if mid-cheek support below the bag area is required to provide buttressing and Belotero Balance to blend and more evenly transition the mid cheek with the region immediately below the eyes. (In my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available, I typically opt for Stylage XXL for the cheek region and Teosyal Redensity II for the infraorbital region).
Unfortunately, relatively expensive radiofrequency and even ultrasound device treatments, in my experience and frankly also in the medical literature, have proven disappointing and have been showing themselves to be far more device manufacturer marketing hype than hard science--yielding subtle, inconsistent and variable results.
Treating malar bags with injectable fillers and volumizers should not be left to the hands of novice and non-physician or non-core physician injectors whose primary experience is limited largely to injecting laugh lines and marionette lines. Make sure that you seek treatment by a board certified aesthetic physician with extensive experience and expertise in treating the malar and infraorbital regions--even if outside your six hour travel limit-- and be sure to ask to see his/her before and after pictures.
Malar bags can be very difficult to treat. There are several different approaches depending on an individual's situation.
1. If there is mild depression underneath a small malar bag, it can be filled with a filler. Typically it is an extension of the tear trough on to the cheek itself. I like to call it the cheek trough.
2. If there is a large malar bag that extends into the lower eyelid fat then a lower eyelid blepharoplasty with extension into the malar festoon would correct the problem.
3. In individuals that lack volume in the cheek, either cheek implant or deeply placed fillers such as Voluma, Radiesse or Sculptra can fill that void and reduce the malar bag appearance.
4. If a malar bag is mostly from loose skin then Thermismooth treatment will tighten the skin and reduce the bags.
5. A difficult case that does not respond to individual treatments as mentioned above, a combination approach can be used such as midface lift combined with fillers and/or cheek implants and Thermismooth.
Hi, photos of the cheeks from the front and side would help in the evaluation. I have treated malar bags on many occasions and they are difficult to hide and impossible to remove. Malar bags result from a genetic predisposition to have localized areas of chronic edema in the cheeks. This slowly builds up to a thick, raised area. Avoiding salt can help. Dermal fillers to soften the edges can also help. Localized skin tightening may also help. The only thing that can significantly hide malar bags are cheek implants (if the cheeks are flat and cheek implants are warranted).
I treat them frequently and use CO2 laser. It is the most effective and predictable procedure I have found for malar bags. You can see info and pictures at my site lovethatface
Joe Niamtu, III DMD
Cosmetic Facial surgery
Not being able to examine or even see any pictures, makes a relevant response to your specific anatomy impossible. In my experience is a surgical approach combining a SMAS tightening and subcilliary, lower blepharoplasty approach to a mid face lift and arcus marginalis release to reposition and reduce lower eyelid fat.
Malar edema is facial swelling over the cheek region. It is like having swollen feet. It is very difficult to treat. Sometimes facial rejuvenation with an extended SMAS may help "mask" it.
Malar bags are frequently not an easy problem to deal with. In my practice I find that utilizing multiple modalities often leads to a superior result. I usually recommend to use a tightening modality first, such as ThermiTight , Thermismooth or Ultherapy, and then add a filler around the bag to coumuflage it. The choice of a tightening option is based on the exam findings (bag location, size, etc). Hope this helps.