What are malar pouches?

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

What causes malar pockets?

The process by which malar pockets form is still poorly understood. It would seem that they appear after the orbicularis muscle has collapsed or slipped, possibly as a result of fatty melting in the cheekbone, preventing it from fulfilling its function of supporting the muscle.

Malar bags can also be due to poor lymphatic drainage in this area, which is common in men and women over a certain age: due to a blockage of lymph, an accumulation of edema occurs, which then turns into fat over the years.

In this case, the volume of the pouch varies from one day to the next, and also changes over the course of the day: malar pouches are often more pronounced on waking, notably because lymphatic drainage decreases during sleep.

There are several possible causes for this mechanism:

• An edema resulting from a small inflammation of the periosteum (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 pockets, including :

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

Various breast pocket treatments

Malar pockets are more difficult to manage than fat pockets. It’s a lymphatic edema, not a fat pocket. It is entirely possible to reduce their appearance. However, they cannot be completely eliminated.

Treatment depends on the severity of the malar pocket.

For moderate forms, cosmetic medicine treatment may be sufficient to deflate the malar pockets:

• Delayed cortisone injection on the periosteum to reduce inflammation of the malar pocket;
• Hyaluronidase injection to reduce edema;
• Injection of hyaluronic acid to fill the submalar volume.

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

For more pronounced shapes, on the other hand, eye surgery should be considered. The operation for the malar pocket is more extensive than the method used for the fat pocket. In this case, the treatment involves a combination of a sub-palpebral lift (to restore tension to the orbicularis muscle of the lower eyelid) and a microlipostructure of the eye ring.

To complete the procedure and perfect the aesthetic result, cheekbone lipofilling is also an option. This procedure involves injecting autologous fat to fill out the volume of the cheekbone and enable it to fulfil its role of supporting the tissues in this area.

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

How to choose the right treatment for malar pockets?

Treatment of malar pockets will depend on whether they are in the early to moderate stages, or very pronounced. In the case of the former, medical treatment with injections is sufficient in most cases.

In his practice, Dr Hayot uses his own expertise: he has chosen to combine several techniques to deflate malar bags: first, he injects very low-dose cortisone to treat the inflammatory involvement of the malar bag. Next, he injects hyaluronidase, a product that dissolves excess hyaluronic acid injected into the dark circles. This combined technique delivers highly significant results in terms of edema reduction.

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

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