Which are the malar bags? (Photo)

The malar fat pad is the area in red.  This is the fat which is sitting on top of the cheek bone.  You don't want to remove this fat pad, but can help to move it up with a surgery to try and smooth out the contour.  Some people have problems with swelling in this fat pad both before and after the surgery.  If you do a lower lid bleph, you will usually not some improvement in the malar fat pad as well.  

A lower eyelid complex chemical peel performed at the time of lower blepharoplasty is an effective option for addressing this type of festoon.  I would recommend profound caution with mid face lift.  I am required to fix many of these because the repair often creates its own issues.

The area you have marked in red represents the malar pad.  True malar bags can be difficult to treat, but can be improved with some lower lid blepharoplasty techniques.  This really depends on the experience of your Surgeon, how he/she approaches the area, etc.  If you feel comfortable with your Surgeon, arrange anotehr discussion to go through all of your concerns.

As all the other surgeons note, the malar bags are the lower ones, circled in red. The blue-circled bags are the medial and middle eyelid fat pads, and the green-circled are the lateral eyelid fat pads. All eyelid fat pads can be improved with lower blepharoplasty. Malar bags, also called festoons, cannot. I have had success lifting the bags independently via transblepharoplasty midface lifts. I have not had success treating them with temporal midface lifts. Camouflaging them with fillers is challenging. This is the most complicated area to treat in the eyelid/ midface, and if not treated during blepharoplasty will often look worse for many months since it tends to hold swelling differently than other areas of the eyelid.

 A lower blepharoplasty procedure  can accomplish  removing protruding orbital fat which creates the puffy look. Malar bags are located in the red  area, and are not addressed with the blepharoplasty procedure. In our practice we do not performing midface lift due to significant complications that can occur with the procedure. In addition, the mid face does not descend vertically with the aging process but loses volume, therefore we place cheek implants over the maxilla when patient's have a flat maxilla and a flat cheek profile. For more information and many examples of both procedures, please see  the link and the video below

The area in red is the malar bag, This area can also referred to as a festoon. This is NOT fat that can be surgically removed like the blue and yellow areas, which can be improved with a lower lid blepharoplasty. The malar bags have been historically difficult to treat, and the goal is more to help camouflage them. Hylauronic injectables can actually accentuate them, so be cautious about placing them in this area. Fat transfer or Sculptra may be a better choice is the cheek requires some volume. I have had luck treating the bags with ThermiTight, which is far easier and less expensive than a facelift.