What are the differences between fat bags and malar bags?

General information on under-eye bags

Fat bags

Fat bags result from an accumulation of fat. The eye is surrounded by a fat pad that protects it from the bony walls. It is separated from the outside by a thin connective tissue called the septum. With advancing age, the septum distends and fat from inside the eye socket protrudes under the skin, forming fat bags.

As fat is hydrophilic, these bags can vary according to a number of factors: a woman’s hormonal cycle, an excessively salty diet, excess alcohol, certain sleeping positions, and so on.

Malar bags

Malar bags appear as swellings located at the top of the cheekbones. They are caused by poor lymphatic drainage, leading to water and fat retention and to the formation of oedema.

This may be associated with the loss of fat at the outer corner of the eye, the cause of the hollow eye, which accentuates the difference in relief and gives a tired, worn appearance.

The differences between fat bags and malar bags

Patients sometimes come to the practice complaining of dark circles when they in fact have malar bags.

To tell fat bags and malar bags apart, it is worth remembering that fat bags are located above the dark circles and disappear when lying down. Lymphatic malar bags, on the other hand, sit below the dark circles, on the upper part of the cheekbone, over the malar bone.

When the patient is standing, the fat bag increases in volume, while the malar bag does not. The latter tends to diminish in volume over the course of the day, the effect being more pronounced in the morning, because of the disturbance of lymphatic circulation.

Finally, unlike fat bags, which are due to the externalisation of intra-orbital fat, malar bags are generally linked to a collapse of the orbicularis muscle and to lymphatic oedema, the cause of which is poorly understood.

Eye surgery: procedures vary according to the type of bags

Unlike fat bags, malar bags are not made of fat. The surgical technique used to remove them is therefore more delicate.

During the consultation, Dr Hayot will therefore take great care to distinguish fat bags from malar bags, which require a specific surgical procedure.

Fat bags

Fat bags are removed transconjunctivally, that is through the conjunctiva (the red part of the eyelid). This technique allows the bag to be removed without cutting the skin and without any risk of altering the look of the eyes. There is no scarring of the skin, and post-operative recovery is minimal. Lipofilling (micro-lipofilling) can also be performed in the case of dark circles.

Malar bags

A sub-eyelid lift is required to restore tension to the orbicularis muscle and reduce the ptosis that causes the malar bag. The incision is made at the ciliary margin, so that the scar quickly becomes concealed, whose visibility depends on healing.

Do you have a question about fat bags or malar bags? Do not hesitate to contact Dr Bernard Hayot, a physician and oculoplastic surgeon in Paris specialising in eyelid & oculoplastic surgery.