Malar bags are getting worse with age. What would be the recommendation for me? (Photo)

Under eye bags can be permanently corrected with surgery or temporarily camouflaged with fillers.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.
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!

Dear   TBLIX,

It appears that you have evidence of fullness in the lower eyelid region and festoons/malar mounds on the cheek as well. These changes can make a person appear tired, sick and older even when they feel fine inside. 

Many people who undergo lower eyelid surgery to improve the appearance of their lower lids are dissatisfied afterwards because of one factor which can complicate the results from lower

Festoons and Malar moudns are a medical condition in which the skin of the lower eyelid becomes significantly damaged, usually by the sun. This damaged skin can result in folds in the lower eyelids and can lead to swollen mounds on the cheeks. They often occur with age and are more common in people with lighter skin types.

Festoons occur in many people seeking lower eyelid rejuvenation and if not corrected at the time that lower lid surgery is performed, the condition can become exacerbated and make the lower eyelids look worse after surgery.

The reason then why many people are dissatisfied after undergoing lower eyelid surgery to improve the appearance of their lower lids is the result of two main issues:

Swelling that occurs in the face after lower eyelid surgery often accumulates in the lower eyelid region and can take a while to resolve.
The subconscious brain constantly looks for balance in a face, and when lower eyelid fullness and festoons exist they are seen to belong together, as both are usually age-related phenomena. When only one is then corrected (usually the lower eyelid bags), the other is seen in even greater contrast.  The subconscious brain then focuses in on this condition and tells the conscious brain the face is out of balance.
Festoons and malar mounds have been a frustration for surgeons for many years. Thanks to the initial work of Dr. Sterling Baker (a person with whom I trained) and my own improvement and refinement on that work over the last decade, I now have a sophisticated, technically-challenging but effective treatment for festoons and malar mounds.

Many people don’t fully understand or recognize the differences between these two conditions. The first difference is in their cause or etiology; festoons are a result of sun-damaged skin on the lower eyelid and on the cheek and are believed to be affected by underlying contrasting muscle forces over the years of a person’s life.

In contrast, lower eyelid bags are due to age-related fat protruding through the skin in the lower eyelid region. New research has shown that fat can grow and atrophy during our lives in asymmetric ways. The growth of fat in the orbit around the eye along with atrophy of fat in the facial regions around the eye, as well as weakness in some of the orbital containing structures, contribute the fullness we see in the lower eyelid with age.

For some individuals, this fat shows up at a very young age and this is believed to a result of genetic changes in the development of the eye area in those individuals.

The second difference is the location on the face where they form. Lower eyelid festoons can be seen primarily on the cheek with some presence in the lower eyelid region.  Lower eyelid bags are located directly below the lower eyelid lashes and are noticed to become more prominent when someone with these bags looks upwards.  Conversely, festoons are minimally affected when a person looks upwards.

The third difference is the feel of these conditions when they are touched. Festoons are squishy and can be made to move side to side. Lower eyelid bags are firmer, deeper in location beneath the skin and can’t be moved easily side to side when touched.

 It is important to understand the differences between these two conditions. The best rejuvenation and most natural results occur when both eyelid bags and festoons are corrected simultaneously.

I'll include some links below.

I hope this was helpful.

Your photos show a combination of tear trough (orbital hollow) and then the lower cheek groove, "orbito-zygomatic" groove that delineates the early malar bags, or festoons, just above it at the highest point of the cheek. The use of Restylane in the orbital hollow (tear trough) is ideal. The orbito-zygomatic groove's proximity to the malar bag, subtle currently, makes the use of hyaluronic acid fillers, which can be hydrophilic and draw in fluid, a little more challenging in this region. I prefer using  Radiesse in this region because the cheek is much thicker soft tissue. The subtle malar bag, at this point, may improve with CO2 laser resurfacing, but there isn't a perfect solution at this stage. We just want to make sure we don't make it worse with fillers.Good luckAJ Amadi

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

The service is very fussy. It is so fussy that I have patients who travel to me from London an Dubai for under eye filler service.  I am not saying that you will need to travel to me for this service. What I am telling you is that the treatment results are amazing but finding someone who can perform this service is challenging. Avoid runny fillers like juvederm, belotero, and restylane silk for this area.

Malar bags are difficult to treat.  Lasers are an option which could help improve this area as well as address skin tone and texture.  See an expert in your area to determine the best approach for you.  I recommend using sunscreen every day as well.

Certainly behavioral changes can help with some of the swelling including keeping the head of your bed elevated, decreasing your salt intake and sleeping on your back. Laser resurfacing can improve this area by tightening the skin and decreasing the overall swelling in this region. 
All the best!
Dr. Diana Tamboli

Hi there,

What you have is descent of the malar fat bags which yields a number of visible lines under the eyes - namely the tear trough and visible lid-cheek junction.

A few options work well for this.  Hyaluronic acid filler is a temporary filler that is relatively inexpensive and can replace volume where it has descended.  You may need to repeat this every year to 18 months but can be done in rooms and on your first consultation.  The other option is to have fat injections which are a permanent solution.  This is likely more expensive but really fixes the problem and replaces fat that has descended with gravity.

See a plastic and reconstructive surgeon with an interest in facial fat fills and filler who can offer you both of these options.  you can then choose what suits you best.
I hope this helps.

Hi tblix,Fat loss, bone resorption, and decreased collagen as we age causes what you termed "aging eyes". Some non-surgical treatments are undereye fillers (we prefer Restylane Refyne) and laser treatment. If you are not a scar/keloid former, microneedling with PRP is ideal because it induces collagen growth.All the best, Justin Harper, M.D.

You are starting to show a division of the small fat pads adjacent to the eye which is genetic. The simplest approach is tissue fillers which are a good start to demonstrate a good appearance and change in the area. Eventually, you may have to consider a procedure blending the cheek back into the lower eyelid with a surgical approach.