I agree that your malar bags are minimal and filler should be the definite first choice. I would not recommend surgery at this time. As you age , surgery can be reconsidered. You may also have some fluid retention that is exacerbating your condition.
Malar Bags? Festoons? Our Fix.
If you have malar bags, or festoons, I would suggest
that you first get checked for a thyroid problem. You may have a disorder
of thyroid function, such as hyperthyroidism or hypothyroidism.
Occasionally, malar bags improve when the underlying thyroid disorder is
treated. In the past you may have had a thyroid inflammation that
liberated thyroid antibodies that cause the cheek swelling.
We have also seen many patients in our practice that have
allergies to various environmental allergens, and suggest chemical allergy
testing if your bags are long standing.
In terms of solutions, many physicians try fillers.
Fillers cause their own set of problems, including, often, worsening of
the malar bags.
Malar bags are tough to eliminate. A lower lid blepharoplasty with elevation of the fat pad and laser on the skin can often help improve the appearance of the fat pads. You should try some filler first to give some volume to the area which will help to make the skin contour more even.
Malar bags are extremely difficult to treat. Even with a lateral lower eyelid incision elevation of the cheek within Orbiculopexy and skin excision malar bags tend to recur. Yours are minimal.
I see would suggest filler injections to avoid the surgery and see if the result pleases you.