Is there any procedure that could fix these lines under eyes or even the whole cheeks? (photo)

Question

I am 21 years old male, with a very bad skin. I had these under-eye lines (i don't know how to call them) since i was born. I generally have awful, thick skin, filled with large pores. I was wondering what could be the solution for this problem? I really don't want to look like 50 y/o man. Thanks in advance

S. Larry Schlesinger, MD, FACS · Answer

Malar bags are the junction between the thin eyelid skin and the thicker cheek skin.  Attempts at suctioning out the fat in the malar bag have unfortunately only given mixed results.  People with thin skin and usually over 50 can do very well with a direct excision of skin and subcutaneous tissue in this area.Unfortunately, lasering this area rarely produces much improvement and tightening of the skin can, at times, lead to a pull on the lower eyelid skin leading to an ectropion (pulling down or out of lower eyelid skin).  Direct injection of fillers into the edge of the malar bag often makes this area more obvious and bulky.If you were my patient, I would do a lower eyelid blepharoplasty with muscle sling removing minimal skin medially, but using a dart of muscle to elevate the lateral canthal area and suture it to the superior lateral orbital rim.  This both tightens the skin and muscle laterally and decreases the overhang of eyelid skin over cheek skin.  An adjunct to this muscle sling would be the use of Voluma to increase the malar eminence for a better blend from lower thinner tissue to higher thicker tissue.

Brian M. Derby, MD, FACS · Answer

You have a mid cheek groove derived from the midfacial ligament and a bulging sub orbicularis oculi fat pad. In simple terms, our facial fat is compartmentalized, and unless you release the walls/ligaments between fat pads with surgery, I find it difficult to smooth out the lines with filler alone. Subcision, or release of the ligament attachments to the skin with a needle, followed by fat grafting may be an option, but I think your looking at a lower bleph in the future for optimal improvement. Best of luck.

Jason Emer, MD · Answer

Lasers, fillers, and peels work best in this area.  I suggest seeing an expert for a formal evaluation.  Best, Dr. Emer.

Kenneth D. Steinsapir, MD · Answer

Without a doubt, the best option for this is hyaluronic acid filler.  I prefer Restylane for this location.  Given your age, it is reaonable to expect that treatment will persist well over a year for you.

Soheila Rostami, MD, FAAO, FAACS · Answer

these malar bags are very challenges to treat. Laser surgery can help; especially, Erbium Yag resurfacing. I have been able to also help this area with very superficial injection of fillers in the line as well as make the cheek stronger. Lower eyelid surgery is not the answer but mid-face lift can help.

Is there any procedure that could fix these lines under eyes or even the whole cheeks? (photo)

Answers (8)

Answer: This is a mid cheek groove.

Answer: This is a mid cheek groove.

Answer: These are called malar bags ( fastoons), and very hard to treat

Answer: These are called malar bags ( fastoons), and very hard to treat

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Everything you need to know about Eyelid Surgery

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Is there any procedure that could fix these lines under eyes or even the whole cheeks? (photo)

Answers (8)

Answer: This is a mid cheek groove.

Answer: This is a mid cheek groove.

Answer: These are called malar bags ( fastoons), and very hard to treat

Answer: These are called malar bags ( fastoons), and very hard to treat

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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.