62, facelift did not help. What are the best options to get rid of malar mounds? (Photo)

Question

Looking for opinions on best procedure to get rid of malar mounds. I have done a lot of research and seems there is no clear answer. I am considering direct excision. I have had a facelift one year ago with no change to the malar mounds. I am 62 years old. Thank you

Lawrence Kass, MD · Answer

You are certainly correct. You do have malar mounds, which also may be referred to as festoons or malar bags. And yes there is no consensus as to the best treatment.
 But for sure they are not helped by a facelift or by lower eyelid surgery and, in fact, may be worsened by these procedures. Direct excision is possible but this carries a real risk of leaving unsightly scars in the middle of each cheek.  I personally think better options exist and you may want to check them out. 
  I personally participated in a upcoming podcast where 3 or 4 surgeons (including myself) discussed our own techniques for treating this problem. You might want to have a look at this procedure on my website, paying particular attention to the before and after photos posted. I would be happy to speak to you if you are interested.
  Good luck!

Gary M. Horndeski, MD · Answer

Your photograph is limited.  However, you may have excess fat of the lower eyelids and may benefit from a lower blepharoplasty with fat transposition.

Best Wishes,

Gary Horndeski, M.D.

Pasha Mostofi, MD, DMD · Answer

Hi there. Malar mounds can be one of the more frustrating areas around the eyes and upper cheeks because they are often caused by a combination of swelling, weakened tissue support, fluid retention, and changes in the skin itself, not just “loose skin.” That is why a facelift alone sometimes does not improve them significantly, even when the rest of the face looks rejuvenated. Based on your photo and history, direct excision can be effective in carefully selected patients, especially when the fullness is more fixed and prominent, but it does come with the tradeoff of a visible scar risk in a very delicate area of the face. Other options that are sometimes considered include lower eyelid tightening procedures, laser resurfacing, chemical peels, or treatments aimed at reducing chronic swelling, though results can be variable and often incomplete. In some patients, filler can actually worsen the appearance, so caution is important there. The most important step is determining whether the mound is primarily fluid, skin laxity, fat, or scar-related tissue from aging and prior surgery, because treatment success depends heavily on matching the procedure to the underlying cause. I would strongly recommend consultation with a facial plastic/cosmetic surgeon or oculoplastic surgeon who has extensive experience specifically treating malar mounds, as this is a very specialized problem and one of the more challenging areas in facial rejuvenation. Hope this helps!

Darryl J. Blinski, MD · Answer

Great posted photos I recommend laser Junera treatment to improve malar mounds. Under local anesthesia each session $4,000. Best to virtual consult with

62, facelift did not help. What are the best options to get rid of malar mounds? (Photo)

Answers (4)

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