How to treat malar mounds. (photo)

Question

Hi, I'm 30 and have what I believe to be malar mounds, which is worse under one eye (pics attached). I've been using retinol and sunscreen and practicing a good skincare regime, however i understand that this won't help with malar mounds. I'm wondering whether there are any potential treatments available for this. Thank you

Edgardo Zavala, MD · Answer

Although a complete evaluation would need a personal exam, from your pictures I think that what you have is lower eyelid fat bags and not malar festoons. If this is confirmed during your exam a lower eyelid trans-conjunctival blepharoplasty would solve the problem and a mid- face filler would add volume to the areas needed to blend the cheek into the eyelid to correct the tear trough. I do not think that non invasive means to treat this would be as good as what I recommend. Good luck

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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Adam Scheiner, MD · Answer

Dear Nimsak89,It appears you have a combination of lower eyelid bags from fat prolapsing forward into the lower eyelid space and malar mound or festoons.Its best to address both conditions when considering lower eyelid rejuvenation. The lower lid bags can be removed or repositioned surgically. The malar mounds or eyelid festoons can be tricky to improve but I've had success using lasers to help improve the appearance of this condition. Ill include a link below.I hope this was helpful.

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Brian M. Kinney, MD, FACS · Answer

Thank you for your question. We have
found out something which takes time for many people to learn. Superficial skin
treatments do not affect the deeper layers. That’s one of the reasons why
lasers usually don’t work on malar mounds. To address the fluid and
distention of the tissues, you need a tightening procedure at a deeper layer,
something that ThermiTight could address if you wish to avoid surgery. The ThermiTight procedure of the eyes is an evolving area of
treatment that I as medical director of Thermi have been privileged to lead. Hope this helps!

Camille Cash, MD · Answer

Thank you for your photos and questions.  Due to your age you may want to try non surgical approaches before looking into surgery. You will benefit most if you have a combination of treatments.  Conservative use of fillers can help disguise the irregularities under the eye.  Lasers can help with texture and quality of the skin.  Continue with sunscreen use, which is important.  I encourage you to visit with a board certified plastic surgeon in your area to learn more.

Dinesh Maini, MBChB · Answer

Dear Nimsak 
Thank you for your question and pictures that show an under eye festoon.
Under eye festoons are very difficult to treat successfully whereas malar mounds are much easier. Lots of treatments are reported in the literature because there is no set way that works for each one.
They need a combination of tightening the skin of the festoon CO2 laser works well and deep lifting often using filler but you need ti see someone very experienced otherwise you are wasting your time and money.Good Luck Kind Regards Dr Dinesh Maini Zenith Cosmetic Clinics

David A. Schlessinger, MD · Answer

Malar mounds (also known as festoons) are areas of the upper cheek that swell and give a baggy appearance. These can be treated a variety of ways including laser resurfacing, dermal fillers and even surgical removal.As I look at your pictures it appears that you don't truly have malar mounds, but rather have an eyelid bag with relative hollowness of the tear trough. I think you would be a good candidate for dermal fillers in the tear trough or possibly a blepharoplasty with fat transfer or fat grafting.You should seek the opinion of a surgeon that specializes in this area such as an Oculoplastic Surgeon with cosmetic experience, to evaluate you and discuss all options.

Adam Goodwin, MBBS, FRCS(Plast) · Answer

so as we hit our thirties the early signs of mid facial ageing tend to begin. In your case I think this shows in a bit of mid facial volume loss and a little mid facial descent. This results in exposing of the lateral cheek bone structure and a flattening of the malar area from the side. From the front this can look like in your pictures. I would have to meet you face to face but I imagine that you are getting the early signs of nasolabial lines too. My advice would be to consider revolumising the cheek and lateral malar area to bring height and value back to your upper cheeks Almost everyone when they get to mid thirties has some element of this so don't worry. Iff you are anywhere near the north west I would be happy to see you. Hope that helps. Adam Goodwin

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your question. Many patients have similar concerns regarding how to address lower eyelid bags. Fortunately, there are many products and techniques available to help. The core of a treatment regimen is your daily skin care plan. From there, you will graduate to injectables (e.g., botox, juvederm), skin resurfacing (e.g., laser, RF), and ultimately to surgery (if needed). I suggest that you seek evaluation for a lower eyelid lift. Of course, you will need an in-person consultation to evaluate you for these procedures. Preoperative visualization with the Crisalix system may help with your decision. Your treatment plan should be based on a detailed discussion with equal input from both you and your surgeon.    Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a surgeon you are comfortable with. I recommend that you seek consultation in person with a qualified board-certified plastic surgeon. Good luck! 
Best,
  
Jon Ver Halen, MD FACS
  
Harvard educated plastic surgeon

How to treat malar mounds. (photo)

Answers (10)

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