I've had malar bags for a couple of years now. Is there a way that I can treat them for a youthful appearance? (photo)

Question

I’ve been seeing these Malar Mounds on my cheeks for a couple of years now. Every time I have too much wine or cry they get worse. I would like to treat the problem now so that I’m not always embarrassed to go outside after a few glasses of wine. I do have hypothyroidism and I’m a type 1 diabetic. I’m also scheduled to see a allergist.

Adam Scheiner, MD · Answer

Dear Vancouver,It appears from your photos that you have evidence of fullness in the lower eyelid region and festoons/malar mounds on the cheek as well.
These changes can make a person appear tired, sick and older even when they feel fine inside. 
  
The best options would be surgery to remove or relocate the fat in this region and a procedure to improve the skin quality in the lower eyelid at the same time.
  
Festoons and Malar mounds are difficult conditions to treat but I've had success using laser to help with this condition.
  
I'll include some links below.
  
I hope this was helpful.

Thomas Buonassisi, MD · Answer

Thanks For your question and for submitting your photos it really helps. 
Your Right you have malar bags. These are fluid collections in the upper cheek that occur in many people. Allergies medications etc can influence their appearance. And as you know the size of the bags varies from day to day. They generally look the worst on the days when you have something important like a job interview. 
Fluid retention, salt intake and sleep can impact the appearance of malar bags. There is no good surgical intervention for this, but some non surgical treatments can help. I would see your allergist first and get some insight into what your may be reacting to. We often camouflage the area below the bag with fillers like Restylane and some laser treatments can improve the area slightly. Lymphatic massage to decrease the fluid accumulation has a fairly instant although short term effect.
Good luck!

Harold J. Kaplan, MD · Answer

Hi LC.  In the first photo (yellowish lighting), you can see that the indentation you are concerned about is an extension of what we call the nasojugal groove, which starts at the inner corner of the eye.  This groove is present at the transition of the skin from the cheekbone to the fat that surrounds the eye.  To make this transition look smoother, and to fill the dimpled area below the cheekbone, consider a dermal fillers such as Restylane or Juvederm.  These are Hyaluronic Acid based fillers that work very well for the concern you have.  To see an example of what dermal fillers in this area can do, click on the link below for before and after photos.

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

Jonathan Kulbersh, MD · Answer

This can be permanently corrected with surgery or temporarily camouflaged with fillers.There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eyelift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye.
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression.
I hope this helps!

Camille Cash, MD · Answer

I would begin by making sure your allergies and thyroid condition are well controlled.  Once that is accomplished you can consider your options for the under eye area.  Malar mounds are difficult to treat, but some have had success with laser treatments.  Hollow areas under the eyes can be disguised by the use of fillers, which can last up to 9-12 months.

Brian Windle, MD (retired) · Answer

Thanks for adding your photos.  That is helpful.  They indicate that your concern is not really malar bags (also know as festoons secondary to periorbital edema).  It looks like you have deep tear troughs or nasal jugal grooves.  What you have is actually pretty normal for most people but in your case the toughs are a little deeper and a little longer than usual.
Tear troughs are actually very easy to fix with fillers.  The shorter term fillers that last about a year can be used but I prefer Bellafill for this problem since it lasts for at least 5 years.  In addition, it act to stimulate your own tissue so it looks more natural when placed properly with a cannula.
I have added a video and a web reference about this for you.
I hope that helps.
Best regards.

I've had malar bags for a couple of years now. Is there a way that I can treat them for a youthful appearance? (photo)

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