How do I get rid of malar bags?

What are malar bags?

Malar bags are located at the bottom of the dark circles, under the lower eyelid and at the top of the cheekbones. They sit much lower than fat bags and are made up of lymph. They can be recognised by their puffy appearance, which gives the eyes a “double-bag” effect and ages the face considerably.

What causes malar bags?

The process by which malar bags form is still poorly understood. They appear to develop after the orbicularis muscle has collapsed or slipped, possibly as a result of fat melting in the cheekbone, which prevents it from supporting the muscle.

Malar bags can also be due to poor lymphatic drainage in this area, which is common in men and women beyond a certain age: when the lymph is obstructed, oedema accumulates and turns into fat over the years.

In this case, the volume of the bag varies from one day to the next, and also changes during the day: malar bags are often more pronounced on waking, notably because lymphatic drainage slows during sleep.

There are several possible causes for this mechanism:

• Oedema resulting from a small inflammation of the periosteum (the membrane) of the malar bone;
• Lymphatic stasis;
• A muscular festoon after relaxation of the orbital muscle.

Other external factors may be responsible for the appearance of malar bags, including:

• A diet too rich in salt;
• Lack of sleep;
• Alcohol or drug abuse.

The various treatments for malar bags

Malar bags are more difficult to manage than fat bags, as they are a lymphatic oedema rather than a pocket of fat. Their appearance can certainly be reduced, but they cannot be completely eliminated.

Treatment depends on the severity of the malar bag.

For moderate forms, an aesthetic medicine treatment may be enough to reduce the malar bags:

• Slow-release cortisone injection into the periosteum, to reduce inflammation of the malar bag;
• Hyaluronidase injection, to reduce the oedema;
• Hyaluronic acid injection, to fill the submalar volume.

These methods can reduce the appearance of moderate malar bags without the need for immediate surgery.

For more pronounced forms, on the other hand, eye surgery should be considered. The operation for a malar bag is more extensive than the method used for a fat bag. The treatment then combines a sub-palpebral lift, to restore tension to the orbicularis muscle of the lower eyelid, with a microlipostructure of the dark circle.

To complete the procedure and perfect the aesthetic result, lipofilling of the cheekbone is also an option. This involves injecting autologous fat to restore the volume of the cheekbone so that it can once again support the tissues in this area.

The treatment of under-eye bags therefore differs according to the nature of the bag and its size.

How do I choose the right treatment for malar bags?

The treatment of malar bags depends on whether they are at an early to moderate stage or very pronounced. In the first case, medical treatment with injections is sufficient in most cases.

In his practice, Dr Hayot draws on his own expertise: he has chosen to combine several techniques to reduce malar bags. First he injects very low-dose cortisone to treat the inflammatory component of the malar bag. He then injects hyaluronidase, a product that dissolves excess hyaluronic acid injected into the dark circles. This combined technique delivers highly significant results in terms of oedema reduction.

For the most pronounced forms, Dr Hayot strongly recommends surgical treatment, the only way to improve malar bags: a combination of submuscular lifting and malar lipostructure.

Otherwise, Dr Hayot recommends injection techniques, to avoid relatively extensive and invasive surgery.