24 and malar bags. Can I get any advice? (Photo)

You do not have malar bags. What you have is some midfacial volume loss, which can certainly start in your 20s, and is exaggerated when dehydrated, sun exposed, and/or low on sleep. Surgery is not the answer. I would recommend dermal fillers to the cheek and undereye to correct it. Best of luck!

Thank you for your question. You are 24, and asking for advice about malar bags. You add that you don’t sleep much, and have a lot of unprotected sun exposure while working on a cruise ship. You saw a dermatologist, who said you just needed a good rest.
I can certainly help guide you just based on your photo, and without the benefit of a physical exam. As an oculoplastic surgeon practicing in Manhattan and Long Island for over 20 years, I perform upper and lower eyelid surgery every day in my practice, in addition to filler treatments for things like lower eyelid and hollowing.
Malar bags are bulges made up of small pockets of trapped fluid. They are not in the same location in the face as eye bags, which if always present are caused by prolapsed fat. Fluid gets trapped due to environmental factors such smoking, sun exposure, and other causes. Malar bags are very challenging to treat because of the many small chambers where fluid is trapped.
However, you don’t appear to have malar bags as you don’t have lateral bulges. What you appear to have is premature volume loss, or hollowing at the upper cheek. I would actually treat upper cheek hollowing and some cases of malar bags the same way, by blending the relative hollowness with the rest of the cheek using a cosmetic hyaluronic acid filler. A thicker filler can be injected into the cheek to make volume more continuous, and blend with the rest of the face. Thicker hyaluronic acid fillers for areas that don’t move so much with facial expressions can last 1-2 years, and you will need periodic maintenance as they do get safely metabolized by the body. I wouldn’t recommend permanent or semi-permanent fillers as the materials used are not as safe, and they are difficult and costly to remove if needed. Hyaluronic acid naturally occurs in the body, and these fillers can be dissolved with the injectable enzyme hyaluronidase, if needed. I may consider a less viscous filler for the under eye area, if it’s needed there. These softer fillers are more appropriate under the eyes because of facial movement from expressions, and can last about a year.
I suggest you meet with doctors experienced with facial aging treatments to learn about your options. At 24, you are quite young to be experiencing facial aging changes, but it may be been due to environmental factors, or genetics. I hope you found this information helpful. Thank you for your question.