Mid Face Lift for Malar Bags?

Malar bag
correction is a complex problem that has to be individualized based upon the
cause of the problem. In some cases, it may be the skin or the skin muscle
repositioning of the lower eyelid/cheek junction. If it is really significant,
one may do direct excision. This needs to be done in the hands of a Board Certified Plastic Surgeon who
has expertise in this area.

Malar bags are one of the more difficult problems seen in
facial rejuvenation surgery. A large
variety of procedures have been utilized to treat this problem. Unfortunately none of these procedures are
uniformly successful or have a high degree of predictability.The mid
facelift has been proposed as a possible solution for malar bags.
Unfortunately, the majority of plastic surgeons feel that this procedure isn’t
indicated for this problem. They feel
that it’s not reliable and is excessively aggressive.When
patients have malar bags they should be carefully evaluated by a board
certified plastic surgeon. This surgeon should be able to formulate a treatment
plan that’s tailored to address the patient’s specific anatomic deformity.

This is the million dollar question, ow to treat malar bags.

I have my own theories (a theory and 25 cents will get you a cup of coffee as they say) about what causes malar bags.

There is an anatomic septum that runs through the cheek.  It is not age related, although the bags get worse when tissue from above sags onto the inflexible malar septum.  

It often helps to do a cheeklift not at a subperiosteal level, but at a suborbicularis (underneath the eye muscle).  I have published a bit on this technique, and while it doesn't 100% fix every malar bag, it does help decompress the sagging due to sagging, edematous tissues onto an impenetrable septum.

Tissues that cause ablative changes must be carefully considered as they can pull down on the lower eyelid as more tightening is performed.