Malar Mound. Fixable With Fillers? (photo)

Question

I have developed a fairly nasty malar mound on the right side of my face, and not the left. My right under eye area looks 10 years older than my left. It's probably because i sleep on my right side, but I want professional opinions. Is it fixable with a filler or is it going to need something more? I know there is a Doctor in Florida using a laser with incredible results, but that's in Florida. Any answers would be appreciated, especially from Colorado doctors

Theda C. Kontis, MD · Answer

There seems to be much interest in this topic recently, so I would like to explain this complex anatomy in my answer to your question. This is a very hard area to treat and the fact that doctors all use different names for anatomical defects makes this all very confusing.

	 

	So, let's start with the anatomy. There is fat that can bulge out from under the eye which is seen more prominently when you look up. This is called orbital fat herniation or "bags" and is the most common reason we perform lower eyelid surgery. This fat surrounds the eye and as we age (or sometimes can be hereditary in younger patient) bulges outwards. The fat can be removed or repositioned to reduce the bulge, by routine blepharoplasty surgery. 

	 

	You correctly described your anatomic deformity as a malar mound! This is a triangular area surrounded by two very firm ligaments around the eye. These ligaments are not very permeable to water, so fluid can be trapped in the space and in the fat pad between the ligaments and swell to make the malar mound more prominent. Because this area is so responsive to water levels, it can worsen if you have a salty diet one day and you retain water. It can also be worsened by some medical conditions including hypothyroidism and allergies.

	 

	The last type of lower lid deformity is a festoon. This is a hammock-like sling of fat and skin than hangs under the lid. This is what the doctor in Florida is treating with eyelid surgery and laser resurfacing to tighten the skin. Malar mounds are NOT festoons (however, they might be a precursor to them).

	 

	In my opinion, malar mounds are one of the most difficult areas to treat on the face. I have had some success with fillers used to camouflage the fat. I do not use Juvederm in this area because it also pulls in too much water--I prefer Restylane or Belotero here. I have also tried cautery of the fat pad through the skin, malar mound suspension through a blepahroplasty subciliary incision, midface lift, fat augmentation and laser resurfacing. None of these treatments is 100% effective in treating malar mounds.

	 

	I would suggest you see your medical doctor to make sure you do not have a medical problem before considering treatment. Certainly sleeping with your head elevated (and not on your left side!), cool compresses, a low salt diet and even compression may help.

	 

	Thank you for addressing a very trendy topic. Best of luck to you in treating this difficult problem.

Thomas A. Narsete, MD (retired) · Answer

Thank you for the e-mail. Because of the limited photos, it is hard to answer your question. Try calling a board certified plastic surgeon in your area  Discuss a few options for your treatment. Best Wishes

	Dr Thomas Narsete Austin, Tx

Malar Mound. Fixable With Fillers? (photo)

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Malar Mound. Fixable With Fillers? (photo)

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