Can a Face-lift Help Wih Malar Bags and Sagging Skin at 40? (photo)

Even as a young man I lacked a defined mid-face structure : flat cheekbone and low cheek with mouth corners pointing downward. At 35, and my tear troughs started being pretty hollow and that made me look tired and gaunt. I had some injections that actually did fill my under-eye part (with no lumps) bu the tear trough was then replaced by a malar bag and its disgraceful shadow. Would a plain facelift help ? Because i know that the cheek-lift is very hazardous and unpredictable.

Doctor Answers 25

Submalar Cheek Implants Recommended

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As an oculofacial cosmetic plastic and reconstructive surgeon, practicing in New York for over 15 years, I would be more inclined to suggest the placement of submalar implants as the area below your eyes are relatively lacking in volume. Looking at your photos,You may also consider a filler such as Radiesse or Sculptra to correct this relative volume loss. I wouldn't recommend a facelift as the benefits would be limited and the incisions as well as the change in your hair bearing skin on the side would be less than desirable. Consult with a qualified facial cosmetic surgeon.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Facelift will not help malar bags and sagging skin of 40 yo

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At age 40 it is pretty unusual to see true facial sagging and excess skin.  Malar bags can only be minimally helped with a facelift and consideration should be given to small cheek implants.  The implants are placed over the maxilla to restore fullness to the cheek area and reduce gaunt appearance.  This can be done as an outpatient procedure under brief general anesthetic and takes approximately 30 minutes to perform.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Malar cheek pockets

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Malar cheek bags are very difficult to change, because the skin  often has  a loose quality that can not be improved with the usual facelift, namel the lift that tends to pull the facial skin slightly upward but more commonly in a posterior fashion.  The better approach would be to perform a more vertical lift.  One may also have to undermine the skin  and deep facial tissues over the malar bones and subsequently elevate the cheek skin vertically, as well as to anchor the "flap" (as the skin will be referred to)  to the lateral edge of the orbit with stitches  under the skin.


Most Plastic Surgeons will know how to deal with this problem, so please ask your local professionals about how they would deal with this.


Good luck to you.


Frank Rieger M.D.  Tampa Plastic Surgeon

Sagging midface and cheek skin treatment

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A standard facelift won't address the midface area that is concerning you. A midface (or cheek) lift would help address some of the lack of volume in the cheek area. However, as I see it you don't have enough volume in the area to reposition.

Much of this issue, like you mentioned, is related to your relatively flat midfacial bone structure. With the additional skin volume loss that naturally occurs starting in the late 20s/early 30s the gauntness and tired appearance then became noticeable.

In these types of situations I find that volume restoration is the best treatment option. Skin filler injection or facial fat grafting can be used. Additional volume can be attained to compensate for your underlying bone structure and a more rested appearance can be achieved while avoiding an over-done, operated on appearance.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Facelift at 40

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Some type of a facelift might be good to reposition your cheek fat pads on your cheek bones. It would also improve lower eyelids.  Recent studies have shown that facelifts under the age of 50 last longer and have higher patient satisfaction than those done in the  fith or sixth decade.  See my blog on that subject.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Face lift for malar bags

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Simply stated, a facelift will not help your situation. Maybe others will have a better answer for you. 

Sheldon S. Kabaker, MD FACS
San Francisco Facial Plastic Surgeon

About a Facelift & Combining Procedures

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A #facelift is a surgical procedure designed to remove the major folds and wrinkles that form on our faces with age. Gravity, sun damage, smoking, living in a dry climate, and a variety of factors contribute to the aging process of our faces. Facelift techniques vary from patient to patient to give each person a procedure tailored to produce the best possible surgical result. A facelift will smooth out major folds and #wrinkles, #tighten the tissues beneath your skin, remove #sagging and excess skin. A facelift can also reduce excess skin around the #neck and #jawline.  

It is possible to #combine. In fact, I commonly recommend other procedures to go accompany a facelift, such as blepharoplasty or a midface (cheek) lift, to name a few. The combination of multiple of facial procedures may create an optimal result. The best procedure approach will be discussed in greater detail during your one-on-one #consultation. I invite you to visit to view a complete list of surgeries commonly performed. 

The first step is to seek a board certified plastic surgeon who is highly trained with your desired procedures. I also encourage you to look at before and after photos of the surgeons actual patients. Also, reading patient reviews of those who have had combined surgeries will be beneficial. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Facelift Will Not Help Malar Bags Volume Needed For Midface

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Thank you for your question and photographs.

A facelift will not correct malar bags. The only procedure I have found that can improve malar bags is a specialized eyelid procedure called a lower eyelid pinch blepharoplasty with orbiculopexy which involves tightening the lower eyelid muscle which can pull the skin of the malar bag upwards.

You can also benefit from adding more volume to your mid face and if you are having in eyelid procedure then fat grafting into the tear trough and cheek will help restore cheek volume and improve the nasal labial fold region.

Be sure to consult a plastic surgeon who is certified by the American Board of Plastic Surgery, is experienced in facial and eyelid rejuvenation surgery, and has an excellent reputation in your community.


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Your midface fat compartments have very little fat within them, I would suggest facial fat grafting for a long term solution

Malar bags are challenging

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Malar bags are challenging to address. They result from a combination of excess skin, edema (swelling) from the lymphatics in your face, and anatomic changes in the underlying muscle and connective tissue. Most surgical procedures including lower eyelid surgery, midface lifts, facelifts, and even direct excision of the area have been inadequate in treating malar bags. Discuss your particular situation with an experienced Facial Plastic Surgeon to find out what options you may have.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.