Malar Bags (Cheek Bag) Treatment Options

I am only 27 years old but have had malar bags forever. They seem to be getting worse over the past 4 years, especially on the right side. I have had two surgeries on my levator muscle in my right eyelid (one at 3 and one at 25) to repair ptosis - so this may explain why my right cheek is more puffy. Is there anything that may be causing this besides heredity? Also, what can I do to lessen their appearance? I feel as though I am way too young to have such prominent malar bags. :) Michelle

Doctor Answers 10

Check your thyroid hormone levels

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Hi Michelle,

Definitely have your thyroid hormone levels tested. If normal, then I would recommend a consult with Robert Goldberg, MD at UCLA. Dr. Goldberg has a technique where he treats malar bags with radiofrequency with success.

Good luck and be well.
Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Live Video Demo Malar Bag Excision and other options explained

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Malar bag excision, lower eyelid lift, facial implants and fat injections for malar bags are options. Direct excision is a more direct way of approaching the malar bags. Although I show a video on the direct excision it is probably not my first choice. I would rather carry out fat injections to smooth the bags out.  The lower eyelid lift tends to remove fat from the lower eyelids and lifting of the muscle and skin can benefit the bags in the malar area.  Implants can help by filling in some of the void but are a second choice. 

Philip Young, MD
Bellevue Facial Plastic Surgeon

Malar bags

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there are a number of causes for malar bags or whats often referred to as festoons. If there is lid ptosis or sagging this must be addressed specifically. However the malar bags are often treated in my practice with either  the erbium laser or the new CO2 fraxel laser.  If done carefully both lasers can easily shrink the malar bags symmetrically and leave the eyelids in their normal position. The proceedure is easy, done under local anesthesia and takes 15 minutes.

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Malar Bags Treatments

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Malar bags are on of the most difficult things to treat on the face.  Malar bags as a result from edema can be from a host of medical causes (i.e. allergies, thyroid, etc) are notoriously difficult to treat.  Treatments which fibrose the lymphatics can sometimes improve the appearance.  Isolated kenalog injections can help fibrose the lymphatics here with variable success as can some radiofrequency devices.  

Malar bags as a result of muscle excess are more easily treated and can be treated by some reshaping the orbicularis oculi muscle (lower eyelid muscle).

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 171 reviews

Malar bags have many causes

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Michelle, there are many causes of malar bags, and finding the correct treatment depends on the cause.

Sometimes malar bags are caused by fluid collection. Fluid collection usually varies a little over time--often a little worse in the morning than at night. The fluid usually comes from allergies, but it can also come from other things, like eating too much salt or having a low thyroid level.

Sometimes the bags are just contour defects. This can be inherited or due to loss of fat in the cheek beneath the bag. Surgery to remove the fat or fillers in the area of fat loss will help if this is the problem.

And sometimes the bags are due to skin that has been stretched and is now loose. This can be treated with laser, radiofrequency or surgery.

I suggest that before you decide what treatment you want, you talk to your doctor and figure out what is causing your bags. Then you will be in the best position to find the treatment that is most likely to work for you.

Good luck!

Nancy Swartz, MS, MD, FACS
Philadelphia Ophthalmologist

Malar bags difficult to correct

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Malar bags can be difficult to correct. Laser resurfacing combined with a lower lid blepharoplasty can greatly reduce the appearance of malar bags. It may be necessary to perform laser resurfacing twice – six months apart.

The cause of "malar bags" can be localized edema fluid, poor lymhatic drainage, excess fat and poor quality skin or skin damage.

Fred Suess, MD (retired)
San Francisco Plastic Surgeon

Cheek Bag Treatment

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There are several different reasons as to what causes Malar Bags, from inherited, stretching of the skin hence leaving excess skin, Loss of Fatty tissue. Depending on what has caused the Malar Bags will determine what the best treatment will be. There are several different options, Laser resurfacing, a form of lower blepharoplasty etc. Your best bet would be to seek a consultation with a Reputable Doctor who is knowledgeable and understands the anatomy of this area. Let him/her take a look at your area of concern so he/she can go over your best options so you can make an informed decision as to which treatment will be best.


Greetings Michelle, Malar bags are a difficult problem...

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Greetings Michelle,

Malar bags are a difficult problem to treat. Options that I have found useful include laser resurfacing with lower eyelid surgery and in some cases directly excising the malar bags. Direct excision seems to work the best but may not be a good option in someone your age. It does leave a scar which is usually better than the bag itself but does take several months to heal and for swelling to resolve. In some cases in younger people with minimal malar bags, a resurfacing laser, such as a CO2 laser, can be used, sometimes 2-3 treatments, to get the desired results.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
3.9 out of 5 stars 14 reviews

What to do for malar bags?

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 Malar bags are hereditrary and are caused by scarring due to chronic fluid retention within the upper cheek tissues.  This is a very difficult thing to treat and IMHO, your choices are either:

  1. a thin filler like Restylane, Juvederm or Perlane to feather in the edges of the malar bags or
  2. cheek implants, where the cheeks are also flat, to re-shape the cheek area.  This camoflauges the malar bags.  I have used cheek implants to treat malar bags on numerous occassions.  Micro-lipo and local tissue manipulations, including cautery, of the malar bags does not work, IMHO and can cause more tissue irregularity.

Malar bags are usually due to swelling. It is like...

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Malar bags are usually due to swelling. It is like having swelling in your legs. Unfortunately there is not a lot that can be done for malar bags except to camouflage them.

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.