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Malar Bags

Ask Dr. Wolf questions about all facial plastic surgery, from facelift, eyelid surgery, and rhinoplasty, to non-invasive facial procedures, dermal fillers, and more.

Malar Bags

Postby DCNGA » Mon Jul 21, 2008 3:38 pm

Hello, Dr. Wolf.

Do you know of any new procedures that will address malar bags?

I had a lower (mini-not LSL) lift over 18 months ago. I also had an endo brow lift and lower lid resurfacing done at the same time. About six weeks after the surgeries, the hint of a malar mound/bag/festoon reared its UGLY head. It has progressed to a crescent shape under only one eye. It is a convex crescent shape with no "hanging" or drooping skin thus far. To me, it looks like a how a fresh mosquito bite looks (whitish) but in a larger, crescent shape. Does any of that make sense? It's worsening as time goes by (worsened more after I had Juvederm for TT). It is not allergy related. It is better in the mornings as my face, in general, is more puffy in the mornings so it blends in better with my general puffiness :? . As the day wears on, my face is generally less puffy and the malar mound sticks out like a sore thumb (to me at least). Certain lighting also makes it look more prominent. There is a small (about half the size of the tip of my little finger) area of ptosis like a dent on the orbital rim at the cheek bone, intermingled with the malar bag.

I had a consult with a nationally known occuplast (before it got to this point, about 9 months after my original face lift). He suggested a mini-cheek lift, fat repositioning and a permanent stitch. He said I had very little extra skin and virtually no fat under my eye. I think I now have more skin laxity, but still no fat (I'm thin in stature).

In all my research, I have not read of any really good "fix" for these things. Sorry for my small saga. It's all difficult to explain via the Internet and I have no pictures. It is not easy to capture this with just the right lighting trying to do it myself.

Do you have a special procedure or way to successfully address malar mounds/bags/festoons?

Thank you for your time.

I no longer post on MMH. Please contact me via email.
Posts: 3182
Joined: Tue Apr 05, 2005 12:34 pm
Location: GA

Postby drcarloswolf » Sat Jul 26, 2008 8:17 am

I think if you listen to that famous oculoplastic surgeon your bound to have bigger and "badder" problems. Your research is correct, there are no fabulous treatments for this area. I have actually removes the festoon directly (that's right cutting it out!) from several patients with good results and minimal scars. You can try thermage ,in an attempt to shrink the tissue, I AM NOT A BIG FAN OF THE MID-FACE LIFT,as I have seen some horrible results with it. Steroid injections sometimes improve the swelling as well. You have to have a physician who is experienced with this as sometimes you can get an over correction which will then need injections of a filler to correct. As you can see it is not an easy problem to fix, but there are solutions. If you can take pictures with and without flash I would be happy to see if any of the above treatments might work for you. Good luck.
Good luck
Carlos Wolf MD
Posts: 53
Joined: Fri May 09, 2008 5:52 am
Location: Miami,Florida

Postby DCNGA » Sat Jul 26, 2008 9:07 am

Thanks, Dr. Wolf, for your response. I sort of figured some of what you mentioned was about all that can be done. I worry over having a procedure that would leave scars under my eyes, even if minimal. I'm afraid I would be more unhappy with that than the bags :? .

When I went to the occuplast an internal warning flag went up, so I just instinctively knew that doing that procedure was not a great idea. I went with my gut reaction and opted not to pursue that as remedy.

Hopefully, I'll eventually get some pics of this. The PS who did the TT Juvederm injections called it a festoon, so I know that's the issue. The Juve just drew more fluid to the area, so I won't be doing that again.

Thanks, again, for your time.

I no longer post on MMH. Please contact me via email.
Posts: 3182
Joined: Tue Apr 05, 2005 12:34 pm
Location: GA

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