I have noticed that there is absolutely no before and afters of malar mounds/bags being treated. Why is this?

Question

I have genetic malar bags (which have been made worse recently by filler migration, meaning I have to wait for the filler to dissipate. But, it got me thinking, why is there NO photo proof of ANY patients on this site showing any improvement of malar bags? Surely there must be some filler technique that helps (I would NEVER do a laser as it can cause it to become worse OR even cause fat atrophy, which is a superfluous risk). Anyway do any of you have success Specifically w fillers for this?

Elliot M. Heller, MD · Answer

I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.
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Kenneth D. Steinsapir, MD · Answer

It is not going to happen.  That filler can and will sit there for years.  The treatment is to remove unsatisfactory filler with hyaluronidase assuming that you were treated with a hyaluronic acid filler.  Permanent fillers are a disaster in this area.  If your current physician is telling you that the filler can be helped with enzyme and you need to wait, you need to find yourself a different doctor for help.

John R. Burroughs, MD · Answer

Thanks for asking your question, but without pictures it is hard to give you specific advice that might be helpful.  If your mounds were worsened by the filler then hyaluronidase (an enzyme) will dissolve all hyaluronic acid fillers.  Any fluid retention that remains is not from filler following sufficient enzyme dissolving of the injected filler.  You don't have to wait for filler to dissipate as enzyme can be put in at anytime if it was a hyaluronic acid filler.  Malar bags/mounds are very hard to treat, which is why you aren't finding a lot of pictures for this problem.  CO2 Laser in the suitable patients can be helpful.  Radiofrequency treatment (Inmode RFAL with Fractora Fraxel-type treatment has some success as well if you want to avoid complete laser treatment.  Fillers generally worsen the swelling because they can push up against the lymphatics that drain the tissues of fluid.  I call the mounds the "sponges" of the face as they tend to soak up fluid and swell with salty meals etc.   Non-surgically tetracycline injections can be helpful.  Surgically they can be excised and in older patients this can work well and scarring is usually pretty subtle and many patients feel the scar is a good trade-off vs keeping the "malar mounds" or "festoons."  Surgically supporting the midface and doing dissection down to the mounds can also provide reasonable improvement in some cases.  Best regards.

Michael Zenn, MD · Answer

You are right, there are very few photos of malaria bag correction, likely because it is so hard.  The "bags" are not the typical fat pads seen in lower eyelid fullness.  They are lower in the face and are due to swollen muscle, often from lymphatics.  They do not correct with fillers. They are not in the usual field of a lower eyelid surgery and often go uncorrected.  Make sure your surgeon explains to you your deformity and is doing a surgery that will address the malaria bags specifically.
Good luck!
Dr. Z

I have noticed that there is absolutely no before and afters of malar mounds/bags being treated. Why is this?

Answers (4)

Answer: Malar bags

Answer: Malar bags

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Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

I have noticed that there is absolutely no before and afters of malar mounds/bags being treated. Why is this?

Answers (4)

Answer: Malar bags

Answer: Malar bags

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.