Why is the skin over malar bags more discolored and wrinkly and can it be sucessfully resurfaced?

The skin over the malar fat pad can get very wrinkled in some people.  Sun exposure can be quite severe here which will contribute to the wrinkling.  There can also be intermittent edema of the underlying fat pad which will make the skin appear thinner and sometimes almost translucent.  laser resurfacing can help to tighten up the skin.  This can be done with both non-ablative and ablative lasers.  If you also have the fat pad edema, this usually will not improve with the laser, so improvement can be quite variable.    

Yes, the skin of malar fat bags can have wrinkling and discoloration due to uneven sun exposure, repeated swelling, etc.  I believe the best treatment is to treat the malar bags and smooth them out.  Then whatever skin pigmentation problems remain can be treated with topical treatments.Malar fat bags (sometimes called "festoons") are due to laxity of the orbicularis oculi muscle, which in some people extends down to the cheek.  I have successfully treated many of these with my personal midface lift technique, which is performed through an incision just below the eyelashes of the lower eyelids.  Using some advanced maneuvers, I have been able to lift up and tighten the lax muscle so that it lies smooth on the cheek.I would be pleased to discuss this with you.  Please call 212 570 6080 for a consultation.Elliot Jacobs, MD, FACSNew York City