8 months post op, my Malar Bags returned. What treatment would you recommend?

Question

Hi I have had surgery 8 months ago to address malar bags. I am 47 years old , I had a lower and midline face lift and prior to this surgery a lower eye lid lift ( which was unsuccessful) Immediately after the surgery the bags were gone and I was thrilled but already i am starting to see their return, Obviously they are improved but after spending such a considerable amount of money and a large amount of surgery I am at a loss as to what to do now to treat this reoccurring problem.

Konstantin Vasyukevich, MD · Answer

Thank you for your question.  Unfortunately, malar bags could not be always cured with surgery.  Even though most of them go away after an eye lift procedure, some might recur a few month later.  Retention of fluid in the malar area is responsible for the bag's return, however, most patients would still see significant improvement after surgery.  Additional surgery rarely helps to improve the situation. The best treatment at this point might be using fillers or fat grafting to the cheeks.  This will not remove the bags, but will make them much less noticeable.  Best of luck!Dr. Konstantin

Vincent N. Zubowicz, MD · Answer

If what you're describing is festooning of the orbicularis muscle this will require suspension as part of lower eyelid surgery. It would be useful if you could provide a photograph.

Robert Glasgold, MD, FACS · Answer

Unfortunately there is no great treatment for malar bags.  The underlying anatomy causes this, essentially there are attachments of the skin down to the bone that create the triangular delineation on the cheek which we see as malar bags.  Facelifts and lower eye lifts do not get rid of malar bags.   You can make the overall eye-cheek region look better by adding volume (fat or filler) in deficient areas in the mid cheek and lower lid accompanied by removing excess skin and fat in the lower lid region, but in the end I tell all my patients the malar bags are going to always be there to some degree.  In certain more extreme cases  I will excise them but this is reserved for very swollen and elevated bags.

John J. Martin, Jr., MD · Answer

This is a tough area to improve in many patients.  There is a fat pad there called the malar fat pad.  In some people this fat pad tends to hold onto fluid and become puffy. In addition the skin can be very thin and look swollen and crepey.  If you have already had a blepharoplasty which can often help by removing and tightening the skin, I would try a laser resurfacing.  This can help to tighten the skin and thicken the collagen under the skin.  You should see some improvement, especially if you looked good after the previous surgery. That indicates your skin tone is pretty good.

Robert M. Freund, MD · Answer

Without photos, it is impossible to understand what is bothering you. However, a finding that may be what you are describing is Festoons. This is a swelling of the lowest portion of the eyelid muscles. You will see swelling on the outer portion of the eyelid muscle, over the cheek.A Festoon is an anatomic variant - It is genetic. The only way to permanently remove festoons is through direct excision. Lifts will only relieve the swelling temporarily.Good luck!

Robert H. Hunsaker, MD · Answer

Without photos it is impossile to offer any meaningful advice. Perhaps you could include pre and post ops for our evaluation?

George Commons, MD (retired) · Answer

Malar recurrent bags are not a rare problem.   They can be treated with more surgery but there are simple things to do that can help.   A chemical peel or series of peels over the area  may offer much benefit.  The same can be said of laser.   Chemical peels and laser treatments end up with the same results.  Laser is more expensive.   Rarely severe bags require direct excision.   This should not be necessary but it can be a solution.   Work with your surgeon and you will be fine.   My Best.  Dr C

8 months post op, my Malar Bags returned. What treatment would you recommend?

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