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Malar bags are swellings or pouches that can form under the lower eyelids. They are sometimes referred to as malar edema, malar mounds, or festoons. The appearance of malar bags can be caused by several factors, including fluid retention, ageing, sun damage, genetics, and weakened facial muscles. While the specific cause may vary, the underlying mechanism often involves a combination of excess fat, muscle laxity, and skin laxity. In this paragraph, we will explore the relationship between malar bags and these contributing factors, examining whether excess fat or muscle laxity is the primary culprit.
| Characteristics | Values |
|---|---|
| Other names | Festoon, malar edema, malar mound, tear trough deformities, periorbital puffiness, secondary bags |
| Causes | Fluid retention, ageing, weakened facial muscles, genetics, sun damage, dermal fillers, fatty deposits, loss of fat around the cheekbones, skin laxity, smoking, shifting of fat pads, thinning of the skin |
| Treatments | Laser resurfacing, liposuction, fillers, chemical peels, facelift, cheek lift, Endolift Laser, fat transfer, surgery, direct excision, lower blepharoplasty, mid-facelift |
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Genetics and ageing
The ageing process can lead to structural changes in the skin, such as thinning and loss of collagen and elastin, which can result in shifting of fat pads and fluid accumulation. This shift in fat distribution can cause malar bags to become more noticeable. Additionally, weakened facial muscles, specifically the orbicularis oculi muscle, can contribute to the development of malar bags. Ageing can also cause the weakening of collagen, further emphasising the appearance of malar bags.
Genetics can make individuals more susceptible to malar bags by increasing the likelihood of fatty deposits or weak muscles around the eye area. Genetic factors may also influence the rate at which the skin ages and loses elasticity, making some people more prone to developing malar bags at an earlier age.
While ageing is a natural process that contributes to the formation of malar bags, it is important to note that it is just one of several factors. Sun damage, for example, can accelerate the ageing process and contribute to the development of malar bags. This is due to the damaging effects of UV radiation on the skin, which can lead to premature ageing and weaken the skin's structure.
In summary, genetics and ageing play crucial roles in the development and prominence of malar bags. Ageing causes structural changes in the skin, muscle weakening, and fat redistribution, while genetics can predispose individuals to fatty deposits and weak muscles. These factors, combined with other influences such as sun damage, contribute to the formation and severity of malar bags.
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Sun damage
Sun exposure can cause skin damage and contribute to malar bags and festoons. Festoons are a more severe variant of malar bags, characterised by sagging skin and puffiness under the eyes and on the cheeks. Sun damage can accelerate the formation of festoons by weakening the skin and breaking down collagen and elastin fibres. This damage allows fluids to collect, resulting in swollen skin.
Malar bags and festoons can be treated with surgical procedures such as eyelid surgery, blepharoplasty, midface lifting, and direct festoon excision. Non-surgical treatments include laser therapy, chemical peels, and fillers.
It is important to understand the underlying causes of malar bags and festoons to determine the most appropriate treatment. A personalised approach that takes into account the severity of the condition and the desired results is recommended.
While treatments can effectively minimise or eliminate malar bags and festoons, they may not completely disappear. In some cases, surgical treatment may result in more noticeable improvements than non-surgical options.
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Fluid retention
Malar bags are swelling in the area between the lower eyelids and upper cheeks. They are often caused by fluid retention, ageing, genetics, or weakened facial muscles. Fluid retention in the malar area can be caused by a variety of factors, including:
Lifestyle choices
Lifestyle choices such as smoking, dehydration, and lack of sleep can contribute to fluid retention and the formation of malar bags. Smoking can break down essential collagen and weaken skin structures, while dehydration and lack of sleep can lead to overall fluid retention in the body, including the malar area.
Diet
A diet high in salt can contribute to fluid retention and make malar bags more prominent. Reducing salt intake may help to reduce fluid retention and the associated swelling in the malar area.
Ageing
Ageing is a common cause of malar bags, as the facial muscles weaken over time and the skin loses its elasticity, allowing fluid to accumulate in the tissues around the cheekbones. Ageing also slows down the lymphatic system in the malar area, leading to fluid overload and retention.
Genetics
Genetics can also play a role in the development of malar bags. Some individuals may be genetically predisposed to fatty deposits or weak muscles around the eye area, which can contribute to fluid retention and the formation of malar bags.
Sun damage
Sun exposure can damage the skin and contribute to puffiness and fluid retention in the malar area. Sun damage can break down collagen, weakening skin structures and emphasising the appearance of malar bags.
While fluid retention is a common contributor to malar bags, it is important to note that it often occurs in combination with other factors such as weakened facial muscles, excess skin, and fatty tissue. Treatment options for malar bags caused by fluid retention include surgical procedures such as eyelid surgery, liposuction, and midface lifts, as well as non-surgical approaches like laser therapy, fillers, and chemical peels.
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Fat herniation
Malar bags, also known as festoons, refer to the sagging of the orbicularis oculi muscle, which results in swelling and puffiness around the lower eyelid and cheek area. While malar bags are caused by muscle laxity, they are also associated with excess fat or fluid retention.
In the case of malar bags, fat herniation can occur when there is a weakening of the orbicularis oculi muscle or the skin and tissue around the eyes and cheeks. This weakening allows fat to protrude, contributing to the sagging appearance of malar bags.
While fat herniation can be a factor in the development of malar bags, it is important to note that other factors, such as fluid retention, ageing, sun damage, and genetics, also play a role. The treatment options for malar bags caused by fat herniation or other factors include surgical and non-surgical procedures.
Surgical procedures for malar bags caused by fat herniation may include eyelid surgery (blepharoplasty), liposuction, or direct excision. Eyelid surgery involves tightening the underlying muscles, removing excess skin, and repositioning fat pads. Liposuction involves suctioning out the excess fat, while direct excision physically removes the problematic tissue, including excess skin, fat, or tissue.
Non-surgical procedures for addressing malar bags caused by fat herniation or other factors include laser therapy (such as Endolift Laser), chemical peels, and fillers. Laser therapy tightens the skin, reduces excess fat, and stimulates collagen production. Chemical peels promote new, healthy skin cells and improve skin texture and contour. Fillers, on the other hand, fill up the area around the malar bags to reduce their appearance, but they are temporary and may last from 6 months to 2 years.
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Skin laxity
The loss of collagen and elastin in the skin, as well as the bulging of fat around the eyes, can result in malar bags. In some cases, the weakening of the orbicularis oculi muscle can also play a role in their development. This muscle tends to weaken and lax with age, especially in elderly patients, and its removal may be necessary during surgical treatment for malar bags.
To determine the extent of skin laxity and the appropriate treatment, surgeons may perform a pinch test or a pinch and squinch test. This involves pinching the skin of the malar bag in different areas while the patient makes different expressions. Surgical treatments for malar bags caused by skin laxity include direct excision, lower blepharoplasty, mid-facelift, or a combination of these procedures. Direct excision involves the removal of excess skin, fat, or tissue in the affected areas, offering a permanent solution for reducing sagging and puffiness.
Non-surgical treatments for skin laxity and malar bags include laser therapy, such as Endolift Laser, which tightens the skin and reduces excess fat. Chemical peels are another option, promoting new, healthy skin cells and removing old cells for tighter, firmer skin. Fillers can also be used to fill the areas around malar bags, reducing their appearance by raising the skin. However, it's important to note that fillers are temporary and may last up to a year.
While malar bags can be effectively treated, a combination of treatments may be necessary to address the underlying causes of skin laxity and improve the appearance of the affected areas. Consulting with a board-certified plastic surgeon or specialist is recommended to determine the best treatment plan for each individual.
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Frequently asked questions
Malar bags are swellings or pouches that can form under the lower eyelids. They are sometimes called malar edema, malar mounds, tear trough deformities, periorbital puffiness, or secondary bags.
Malar bags can be caused by a combination of excess fluid, skin laxity, fat, ageing, genetics, sun damage, and weakened facial muscles.
Malar bags can be treated surgically or non-surgically. Surgical procedures include laser therapy, fat transfer, eyelid surgery, liposuction, chemical peels, and direct excision. Non-surgical procedures include fillers and laser resurfacing.
