Surgical improvement of severe malar bags for 25 year old? (Photo)

Question

I've had these since childhood. Tried fillers 3 years ago and had worsening + long-lasting complications. I notice some recommend surgery while others warn against it, and the before/after photos are scarse, but a dr published on this very issue (congenital festoons) 2 months ago which looked promising, any thoughts on that? I realise there is no perfect and easy fix for this, but I'm willing to undergo surgery if I can see significant improvement, is that realistic? Please help.

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Rian A. Maercks, MD · Answer

The first important thing to realize is that malaria bags will never go away completely, some people have them and some people don't.  Luckily from the pictures yours do not look severe.  Treating malaria bags directly with filler is almost always a mistake and usually worsens the appearance as you report.  the good news is that your skin looks good and there is an option that will make them much better, maybe even imperceptible.  You have very little soft tissue volume around your eyes, making them look a bit sunken.  I commonly treat this area with a hyaluronic acid procedure that I call "aesthetic facial balancing" in my practice.  through the correction of this area and lifting the cheek prominence both the looseness of your skin and the angle of the surface changes thus dramatically improving malaria bags.  It is important to note that when you are swollen in the days to a week after the procedure your malaria bags will collect water and appear amplified until the swelling goes away.  This procedure can also be performed with your body's own fat as well.  I would avoid any surgical offerings in this case as they are only likely to exacerbate issues in your case.  I hope this helps!All the best,Rian A. Maercks M.D.

Jonathan Kulbersh, MD · Answer

Under eye bags can be permanently corrected with surgery. 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!

Kenneth D. Steinsapir, MD · Answer

You have may have retained hyaluronic acid filler in the cheeks and this should be throughly removed if it has not been already. Your issue is not a festoon.  Rather your issue is a prominent mid-cheek groove. I strongly caution you regarding surgery for this issue. Your willingness to have surgery makes it likely someone will do surgery for you.  Will it be the right surgery? In my opinion the state of the art treatment for you is hyaluronic acid filer in the midcheek groove.  Getting the right filler and have the right injector is the key.  Don't discard your best treatment option because the first person who performed this for you was disappointing.

David Wee, MD · Answer

Hi there,
Malar bags / Festoon are complex structure of fat pockets on cheekbones. They can be treated with surgery, however, most patients would opt for a non-surgical approach. They may be subtle but under the right hands can deliver better results comparable to surgery. 
Combination treatments are best and few treatments to consider would be Cannula RF (innofill) with fillers surrounding the bags to camouflage the area and skin tightening treatment eg Ultherapy or lasers.

Camille Cash, MD · Answer

Treating malar bags is difficult.  Some patients find improvement with lasers.  A newer treatment to consider is Morpheus8 treatments.  Unfortunately there is not a straightforward solution to significantly improve this concern.

Johnson C. Lee, MD · Answer

Thank you for your photo. 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 sho realistic improvement. Hope this helps!

Johnson C. Lee, MD
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Surgical improvement of severe malar bags for 25 year old? (Photo)

Answers (7)

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