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.

Malar mounds are improved with a mid face lift.  At 30 y/o you probably do not have malar bags (but could- -see your dr. to check your thyroid and medical condition if you do).  What usually happens is that the malar ligaments loosen and the cheek fat pad (properly called nasolabial fat pad) separates from the cheek or malar area producing a groove in between.  This can be minimal in younger people, but bothersome.  If your problem is this, a mid face lift can be helpful in rejoining these two areas.  You can "put a band-aid on the situation" with fillers (we prefer platelet rich plasma for this as it produces an "even' appearance without looking over filled).  However, no filler is a "long lasting" solution".  While we have performed fat injections since 1982, we often find that the bruising and recovery often exceeds that of the mid facelift, and does not produce as "natural" a result.

Of course it is impossible to advise you on the best treatment for your specific situation without examining you but in general early aging changes around the eyes respond to interventions that stress volume enhancement. Some patients will benefit from a fat transposition Blepharoplasty where orbital fat is brought down over the malar prominence smoothing the deflated cheek. Other patients may get by with fillers such as Juvederm or Radiesse. 30 is a bit young for a big procedure like a mid-face lift and it would be the rare patient that age that would not see improvement from a more conservative therapy. I hope this helps.

Malar bags are one of the most difficult problems to treat.  The key step is to look at the underlying anatomic cause:


Muscle excess-  The orbital muscle can sometimes create redundancy along the malar area.  This is one of the more correctable causes of malar bags can be corrected through a lower lid blepharoplasty.

Lymphatics-  Lymphatics are one of the more common causes of malar bags and one of the more difficult to treat.  Sometimes the lymphatic tissues will swell as a result of allergies, thryoid conditions, or other underlying medical conditions.  Treating the medical condition, along with positional changes, low sodium diet, and a variety of other lifestyle changes can sometimes improve this area.  In addition, there are a variety of procedures which may help to shrink the lymphatic tissue.

Excess fat-  Less common for lower eyelid fat to herniate into the malar area (distinct from lower eyelid area) but possible and correctable cause.

Malar bags are one of the most difficult problems to correct. An endoscopic midface lift performed from the temple area I have found to improve these bags by a minimum of 50 % and usually more. Traditional face lift and eyelid lift surgery will not do this.

 These malar bags are the result of fluid collection. They can be improved with surgery to cauterize the area as well as removing tissue. The recovery can be prolonged and the results are not a complete correction of the problem, but improvement.

Dear Sara
Midface surgery will generally not correct your bags.
However given your age, your best option is to have restylane injected around your festoons to fill in the cheek. This will work for you for many years. Treatment will last about a year.
I would advise against Juvederm for this purpose. This agent is a little runny and the filler tends to drift out of the treatment site. This is not seen with Restylane and Perlane.

Many treatments have been used to correct malar festoons ranging from deep laser resurfacing over volume correction to excisions. I certainly would discourage a midface lift for the goal of malar bag reduction. In my opinion, it would be pure luck if it would help.