Is surgery a good option for my malar bags? (photo)

Your photos show a combination problem: prolapsed orbital fat with tear troughs and mild festoons [which are quite difficult to address]I personally believe that fillers in the setting of festoons are not ideal because they can possibly increase fluid retention.There are many different ways to address your concerns, depending surgeons experience/comfort level, and your desires.In my opinion, you would be a great candidate for a transconjunctival blepharoplasty wit fat repostioning. This would minimize volume loss around the eyes and improve your eyelid/cheek transition hollowness. In additon, fat grafting to the malar region would further augment this improvement. Finally, laser resurfacing to the periocular area, as well as the festoons would give you additional improvement of the skin texture with possible improvement of the festoons.I have attached photos of a patient that I performed transconjuntival fat repositioning that has significant improved the contour of her lower eyelids. She would have also benefited from laser resurfacing, though she declined to have that procedure done.Good luck

Thank you for the great question and the photo. Fillers can be an excellent treatment for camouflage of mild under eye circles and bags.  I use Restylane frequently in these cases, but the reality is, the best patients for this are in their 30's and 40's. After this time, there is generally more loose, crepey skin the lower eyelid region and camouflage becomes difficult.  Lastly, as some others have mentioned, fillers can increase the lower eyelid edema. In my practice, for patients with your concerns, I recommend an extended lower eyelid lift with fat transposition. In this procedure, I take the fat bags that are under the eye and use them to fill in the hollow space between the eyelid and the cheek. Then, I removed the extra skin. This gives a smoother, more even contour to the lower eyelid and cheek region, and provides a natural-looking lift for the midface.I would be happy to discuss in greater detail during a consultation. Best of luck moving forward!

Dear Victoria,Looking at you pictures I could not help to notice that you have both eyelid fat herniation and malar bags.  Fat herniation causes the bags right underneath the eyes and malar bags are located a little more to the side of the cheek.  It is fairly easy to get rid of the fat herniation bags with a simple blepharoplasty procedure.  Malar bags, as you've noticed, are a bit more resilient to treatment.  Eyelid or midface surgery can improve them temporarily, but there is no guaranty that they will not come back in a year or two. Fillers often help to make malar bags less noticeable, but they almost never make them completely disappear.   Unfortunately, there is no perfect solution for this problem.  I would like to share with you a few simple lifestyle modification tips that I offer to my patients with this problem.  To minimize the appearance of the malar bags try to  1) minimize the amount of fluid you drink before going to bed.  2) always sleep with you head elevated using a couple of pillows.  3) avoid excessive salt intake during the second half of the day.  I hope this helps you.  Best wishes!