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!         

Surgery (lower eyelid blepharoplasties with canthopexies and cheeklift) are generally the best treatment for those in your (and my) age group, for a variety of reasons usually presented during consultation.  Results can be adjusted for your aesthetic preferences.  Most patients having the procedure wish they'd done it earlier.  Find a surgeon in your area whose "before and after" results you like.

First, very few plastic surgeons, "very good" or otherwise have the expereince, skill and patience to do this type of midface filler.  Judging from your thin skin and lack of cheek fat, your will be a fussy service and you probably need 3 ml of Restylane.  If you are throwing in the towel on this type of treatment ( I would encourage actually to look for a better injector than the one you have tried), your surgical options are complex.  Standard lower eyelid tranconjunctival or transcutaneous eyelid surgery will not be right for you.  Fat grafting will be a mistake in such a thin eyelid.  I think you would benefit from either a chemical peel or a a transcutaneous skin only bleph with a orbitomalar resuspension.

These are tough to deal with. Alternatives are: 1 . Do nothing , 2. Mid face lift, 3. Fillers (restylane). Get several opinions and go with someone with significant experience in this area. Good luck.

You appear to have a combination of lower lid fat herniation and malar bags are evident. You could try to have an injector inject more filler to fll the cheek area and also to mask some of the fat herniation.
Other options could include conservative lower lid fat removal with a cheek lift or cheek implants. Since I cannot see your face completely and it is a photo it is just suggestions of what you may consider and discuss with your local cosmetic surgeon.
It does appear that you have malar hypoplasia. Also malar bags can be difficult to treat in certain situations.

Malar bags are tough to deal with. Often they are "exposed' as the facial fat descends. Malar bags are often considered to be similar to swollen legs.  It is from edema or fluid filled areas that develop and often can not be treated.  

Malar bags refer to fullness in the cheek region that most often relate to loose or excess skin and fat pads. In addition, you photos show a tear trough and lower lid fullness. A comprehensive exam that goes beyond these few photos would be necessary to determine the anatomical components causing these. An analysis should include photos of your earlier years to determine if these are results of aging or merely genetic features. Surgery can very well help in achieving the look to your desire but what specific surgery is needed cannot be determined from these few two -dimensional photos, in my opinion.Robin T.W Yuan, M.D.

Thank you for your question.  I do see mailbag worse on the left side but you also have herniated fat causing puffiness of the lower eyelids.
First and most important is that you should not have a standard lower blepharoplasty to remove the puffy eyelid fat and not address the malar bags.  Doing only a lower eyelid blepharoplasty with fat removal will make the malar bags look much worse.
Mailbags are very difficult to treat but the combination of a lower blepharoplasty with orbicular pexied and cheek lift is most successful treatment I have found.  See an expert oculoplastic or plastic surgeon.