Malar bags and fillers - am I a good candidate? (photos)

Question

Malar bags- am I a candidate for filler or any other non invasive treatment? Or do I need a lower lid blemph. I am 29. I have had one tiny tiny one on my my right cheek since I was a kid but when I turned 23 and they suddenly appeared prominently- they haven’t gotten much worse since then but I think they age me a lot. I take good care of my skin now but didn’t when I was a teenager/my early 20s.

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Nima Shemirani, MD · Answer

Hi @Optimistic2415! If you are looking for a more permanent solution, I would recommend a lower lid blepharoplasty with fat transfer to the tear troughs. Best of luck, Dr. Nima!

Kian Karimi, MD, FACS · Answer

PRF PRO to the under eyes would be a good temporary and non-invasive procedure to help with lessening the hollowing of the under eye area. This result can last around 3-4 months, however, results vary. Additionally, having a filler placed in the lid cheek junction would help transition the area from your under eyes to your cheek area very nicely and lessen the appearance of the prominent crease. If you were looking for a more long term result, then a lower blepharoplasty in combination with a fat transfer to the under eyes would be a possible procedure to consider. Typically, patients will appear overfilled the first few weeks from the fat transfer, however, this fullness lessens as only about 50% of the injected fat will remain. There is a “fat dip” around the 6-8 week mark of recovery which is very common and by the 3 month mark the final results are shown. Going forward, I would recommend you to complete multiple in office consultations with board certified facial plastic surgeons to discuss your aesthetic goals. This way, they can better assess your face and create an ideal treatment plan for you. Best of luck, Kian Karimi MD, FACS

Marc Polacco, MD · Answer

Thank you for your question. As we age, we lose volume but also volume tends to descend. This region is usually one of the first to show. Fillers are popular here to restore lost volume and soften shadows. However, in your case, soft tissue descent appears to be the primary component. There are a few ways to treat this area, but personally I prefer the SOOF (sub orbicularis oculi fat) lift. It's done through an incision on the inside of the lower eyelid, and using that incision, the descended fat is elevated. Again, there are multiple treatments, so take your time and see if you find the one that looks the best to you.

Nelson Lee Novick, MD · Answer

From the photos provided, there appears to be volume deficit-related flattening of the mid-cheek region, which is contributing greatly to accentuation the overlying malar protrusion--frankly a fairly common problem to one degree or another.  Appropriate injection of a robust HA filler, such as Juvederm Voluma XC, to appropriate reinflate the mid cheek region will not only improve the contour there, but should go far in greater a more desirable and gradual transition between the upper cheek and the lower eyelid area. Make sure to consult with an experienced, board certified cosmetic dermatologist, and best of luck.

Levi J. Young, MD · Answer

Hello! Cheek filler may be a great option for you to help with minor volume loss in the medial cheek.

Camille Cash, MD · Answer

Malar bags are difficult to treat.  If fillers are misplaced they can make the area appear heavier.  Some patients find improvement with Morpheus8 which can remodel underlying tissues, improving skin tone and texture.

Richard Ort, MD · Answer

I think that you would be a good candidate for filler placed into the mid-cheek. This would provide support to the lower eyelid area and soften the transition from the eyelid to the cheek. I would use a thicker filler such as Restylane Lyft injected with a cannula. This is a non-invasive treatment and downtime is usually minimal. 
Regards,
Dr. Ort

Jo Herzog, MD · Answer

I think that you would do well with some fillers in your cheeks. If I was treating you I would fill your cheeks and re-evaluate before making any decisions about eyes.

Onir Spiegel, DDS, PhD · Answer

In your 20s and 30s and dealing with under eye bags or undereye hollowness? 
Take control!
Look up teartrough fillers, like Revanesse Versa or Restylane, as well as skin tightening procedures like Morpheus. 
You'll be back in the game in no time.

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