Dominic Stone
Malar mounds, also known as malar bags or festoons, are noticeable bulges or mounds on the cheekbones below the lower eyelids. They are caused by a variety of factors, including ageing, genetics, sun damage, and the weakening of facial muscles and skin laxity. While the exact cause of malar mounds may vary from person to person, the condition is often associated with excess fat or muscle laxity. This can lead to a puffy and swollen appearance, disrupting the natural contours of the midface. Treatments for malar mounds include surgical procedures such as eyelid surgery, liposuction, and laser therapy, as well as non-surgical options like fillers and chemical peels.
| Characteristics | Values |
|---|---|
| Malar mounds | A term used to describe a chronic soft tissue swelling over the cheek |
| Appearance | Noticeable bulges or mounds on the cheekbones below the lower eyelids |
| Causes | Excess fat, fluid retention, skin laxity, genetics, ageing, sun damage, smoking, loss of fat around the cheekbones, weakened facial muscles |
| Treatments | Laser therapy, fat transfer, surgery, liposuction, chemical peels, fillers, eyelid surgery, facelift, cheek lift |
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Genetics and ageing
Genetics:
Some individuals are more susceptible to developing malar mounds due to their genetic makeup and inherited facial structure. Malar mounds can be congenital, meaning they are present from birth, or acquired later in life. People with malar mounds often observe that their family members, such as parents or siblings, also have them. Genetics can influence the shape and structure of the face, making some individuals more prone to developing malar mounds.
Ageing:
The ageing process can exacerbate the appearance of malar mounds. As we age, our skin loses elasticity and collagen, leading to wrinkles and sagging skin. The weakening of collagen and elastin in the skin, along with the bulging of fat around the eyes, can contribute to the formation of malar mounds. Additionally, age-related weakening of the facial muscles can occur, further contributing to the development of malar mounds.
The combination of genetic predisposition and the ageing process can increase the likelihood of developing malar mounds. While genetics may set the foundation, the ageing process can accelerate and worsen the condition over time.
It is important to note that malar mounds can be influenced by other factors as well, including sun exposure, smoking, and certain medical conditions. However, genetics and ageing are two critical aspects that contribute significantly to their development and progression.
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Sun damage
Sun exposure can cause skin damage that contributes to malar mounds and festoons. Festoons are a more severe variant of malar bags, characterised by sagging skin or folds of skin at the top of the cheek. Malar mounds and festoons can result from a combination of skin laxity, drooping and protruding fatty tissue, and fluid collection. Sun damage can break down collagen, a protein that gives skin its elasticity and strength, and smoking can further weaken the skin.
Sun exposure can contribute to the development of malar mounds and festoons in several ways. Firstly, sun damage can cause a breakdown of collagen, a structural protein in the skin that provides elasticity and strength. This breakdown can lead to skin laxity, which is the loss of firmness and elasticity in the skin. Skin laxity can allow the areas around the eyes and cheeks to become puffy, swollen, and sagging. Sun damage can also contribute to fluid retention, which can exacerbate malar mounds by causing further swelling and puffiness.
Additionally, sun exposure can accelerate the ageing process of the skin, known as photoaging. Photoaging can lead to skin thinning, loss of elasticity, and the formation of fine lines and wrinkles. These changes can contribute to the overall appearance of malar mounds by creating a sunken appearance and emphasising the underlying fat pads and fluid retention.
The treatment of malar mounds caused by sun damage can be challenging. Non-invasive treatments such as dermal fillers and Ultherapy may provide temporary improvement, but they do not offer a long-term solution. Laser therapy, such as CO2 laser resurfacing, can be effective in stimulating collagen production and tightening the skin, reducing the appearance of malar mounds. However, it may not completely eliminate them. Surgical procedures, such as lower blepharoplasty, mid-facelift, or a combination of both, can provide more significant and lasting results by tightening the skin, removing excess skin, and repositioning fat pads.
It is important to note that preventing sun damage is crucial in mitigating its effects on the skin. This can be achieved through sun protection measures such as wearing sunscreen, seeking shade during peak hours, and covering exposed skin with clothing.
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Weakened facial muscles
Malar mounds, also known as malar bags, are noticeable bulges or mounds on the cheekbones below the lower eyelids. They are caused by a combination of factors, including excess fat, fluid retention, skin laxity, and weakened facial muscles. While malar mounds can be a cosmetic concern, they may also signal underlying skin and tissue changes that affect overall facial aesthetics.
Genetics also influence the development of malar mounds. Some individuals may have a genetic predisposition to weakened facial muscles or increased fatty deposits around the eyes. Sun damage, smoking, and ageing can further exacerbate muscle weakness and the appearance of malar mounds.
To treat malar mounds caused by weakened facial muscles, various surgical and non-surgical procedures are available. Surgical options include lower blepharoplasty, mid-facelift, direct excision, and eyelid surgery. These procedures aim to tighten the skin, remove excess fat, and improve the contour of the lower eyelids and cheeks. Non-surgical treatments, such as dermal fillers, laser therapy, fat transfer, and chemical peels, can also be effective in reducing the appearance of malar mounds by stimulating collagen production, tightening the skin, and reducing excess fat.
It is important to consult with a board-certified dermatologist or plastic surgeon to determine the most suitable treatment option for malar mounds. They will assess the extent of muscle weakness, skin laxity, and fat accumulation to recommend the best course of action.
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Excess fat
Malar mounds, also known as malar bags, are noticeable bulges or mounds on the cheekbones below the lower eyelids. They are sometimes referred to as tear trough deformities, periorbital puffiness, malar edema, or secondary bags. While malar mounds can be genetic, they can also be caused by ageing, sun damage, or the use of dermal fillers.
Malar mounds can be caused by excess fat, specifically the bulging of fat around the eyes. This can occur due to a loss of fat around the cheekbones, which causes sagging and makes malar bags appear more pronounced. Deep creases can form and trap fat deposits, creating the appearance of an under-eye bag. Additionally, the shifting of fat pads with skin changes due to ageing can contribute to the formation of malar mounds.
There are several treatments available for malar mounds caused by excess fat. Surgical options include lower blepharoplasty, which corrects problems with the lower eyelids or eye bags, and can improve the appearance of malar mounds. A mid-facelift or cheek lift, performed in combination with blepharoplasty or as a standalone procedure, can target the cheek and cheekbone area, tightening the skin and removing excess fat. Direct excision is another surgical procedure that removes excess skin, fat, or tissue in the affected areas, offering a permanent solution for reducing sagging and puffiness. Liposuction is also an effective treatment for removing excess fat through suction, although it requires a skilled surgeon as it can leave prominent scars.
Non-surgical treatments for malar mounds caused by excess fat include dermal fillers, which fill the areas around the malar mounds to reduce their appearance. Hyaluronic acid fillers can be used, but they may need to be reversed with an injection of hyaluronidase. Laser therapy, such as Endolift Laser, can also be used to tighten the skin and reduce excess fat without the need for surgery. Chemical peels and microneedling with radiofrequency are other non-invasive techniques that can help improve skin texture and reduce the appearance of malar mounds.
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Skin laxity
Malar mounds, also known as malar bags, are noticeable bulges or mounds on the cheekbones below the lower eyelids. They are sometimes referred to as tear trough deformities, periorbital puffiness, malar edema, or secondary bags. Malar mounds can be caused by a variety of factors, including excess fat, fluid accumulation, skin laxity, and muscle laxity. While malar mounds can be a cosmetic concern, they may also signal underlying skin and tissue changes.
Ageing is a significant contributor to skin laxity. As we age, the skin naturally loses collagen and elastin, leading to a decrease in skin elasticity. This can result in sagging skin and the formation of fine lines, wrinkles, and creases. Additionally, ageing can cause a shift in fat pads and fluid, thinning of the skin, and other structural changes that contribute to malar mounds.
Sun exposure and damage can also impact skin laxity. Ultraviolet (UV) radiation from the sun can break down collagen and elastin fibres in the skin, leading to a loss of elasticity and increased skin laxity. This, in turn, can exacerbate the appearance of malar mounds.
Genetics can play a role in skin laxity as well. Some individuals may be genetically predisposed to having weaker skin structures, which can make them more susceptible to developing malar mounds. Additionally, certain genetic factors can influence the production and quality of collagen and elastin in the skin, impacting skin elasticity.
Smoking is another factor that can affect skin laxity. The chemicals in cigarette smoke can break down collagen and elastin, leading to weakened skin structures. This can further emphasise the appearance of malar mounds and contribute to skin laxity.
While skin laxity is a contributing factor to malar mounds, it is important to note that it is not the sole cause. Malar mounds can also be caused by excess fat, fluid accumulation, and muscle laxity. However, addressing skin laxity through various treatments like laser therapy, fillers, and surgical procedures can help minimise the appearance of malar mounds and improve the contour of the affected area.
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Frequently asked questions
Malar mounds are a term for malar bags, which are noticeable bulges or mounds on the cheekbones below the lower eyelids. They can be caused by excess fluid, skin laxity, fat, or a combination of these factors.
Malar mounds can be caused by several factors, including ageing, genetics, sun damage, and smoking. As people age, the skin loses elasticity, and the muscles weaken, which can lead to the formation of malar mounds. Genetics can also play a role, with some people being more susceptible to fatty deposits or weak muscles around the eye area.
There are both surgical and non-surgical treatments available for malar mounds. Surgical treatments include eyelid surgery, liposuction, and direct excision, which involves removing excess skin, fat, or tissue. Non-surgical treatments include fillers, laser therapy, chemical peels, and microneedling with radiofrequency.
