Surgery combined with Kybella for congenital malar bags?

Question

Hi, I saw a recently published article in "Aesthetic Plastic Surgery" where a doctor used a surgical approach in combination with Kybella injections to remove malar bags. I notice a lot of doctors recommend against both surgery and Kybella against this, yet it's the only case I've seen of this condition being treated satisfactorily. Could this finally be an option for treating malar bags, or what do you think the future holds for people with this problem? Fillers did not help me.

Adam Scheiner, MD · Answer

Dear NYC,Festoons and Malar mounds are swollens areas on the cheek and lower lid region. They are often related to past sun exposure and tend to appear in those with lighter skin types. They can make a person appear tired sick and older even when they feel fine inside. As described below by other practitioners, this is a difficult condition to treat but I've had success using lasers to improve Malar mounds and eyelid festoons.I'll include a link below. I hope this was helpful.

Jonathan Kulbersh, MD · Answer

I don't recommend Kybella for this. Under eye bags can be permanently corrected with surgery or temporarily camouflaged with fillers (Restylane, Belotero, Volbella).There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye. Lasers can be used in combination to give improvement. 
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

Jason Emer, MD · Answer

malar bags are genetic and lymphatic, kybella rarely helps with this although i have had success with agressive lasers, surgery and/or mesotherapy here. I suggest you see an expert.  Best,  Dr. Emer.

Kenneth D. Steinsapir, MD · Answer

You are in the midst of a cosmetic surgery crisis due to bad treatment and bad advice.  So far, at least reading your posts, you have not done anything that is irreversible. You got a bad under eye treatement and then an inadequate enzyme service.  On top of this you have a midcheek groove.  The improperly placed fillers need to be throughly removed.  This has not happened and even though you had the fillers a couple of years ago, the Restylane is still likely present at the top of your cheeks.  Injecting Kybella in to this glide area and the doubling down with surgery is a good way to get permanently wrecked. Kybella is bad, unpredictable treatment. No one can foresee what will happen if this is injected into your cheek.  A doctor who does this is a bad doctor in my opinion.  Don’t do this to yourself. Start with a complete removal of the old Restylane.  Hyaluronidase will not damage your natural hyaluronic acid.

Luis A. Cenedese, MD, FACS · Answer

Malar bags are notoriously challenging to correct with surgery.  An extended blepharoplasty may correct most of the eyelid and malar bags.  Residual swelling of the area may be improved with Kybella, platelet rich plasma PRP and other anti-inflammatory injections.Kybella in the form of Phosphatydly Cholase/Deoxycholic acid has been successfully used to diminish under eyelid bags for years. Injection is associated with significant temporary swelling. Results are published in medical journals.  Patients typically prefer other options as they result in less swelling.Please consult in person with an exerienced Board Certified Plastic Surgeon prior to making treatment decisions.

Johnson C. Lee, MD · Answer

Malar bags or festoons are difficult to completely resolve due to the complex nature of these bags. Normal eye bags are just fat. Malar bags have a combination of fat, multiple compartments, and recurrent edema or swelling which makes them persistent. This is why filler alone can make them worse as you are adding to volume to the problem. Surgical treatments which release the compartments and remove/reposition the fat may not completely remove them but can show realistic improvement. Kybella is a very new treatment and not yet FDA approved for the eye area. Using it in the malar bags would carry its own set of risks which you should fully understand before proceeding. Hope this helps!
Johnson C. Lee, MD
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Surgery combined with Kybella for congenital malar bags?

Answers (6)

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