Malar Bag Excision

About the Procedure

Malar bag excision is a cosmetic surgery procedure to remove large bags (festoons) below the eyelid, near the cheek area. Malar bag excision is typically most appropriate for older patients who over time have developed large festoons below the eyes. Festoons are large pockets of loose skin that fill with fluid. These festoons are separate to the bags that are often located directly below the lower eyelid, and require a different type of treatment. In this case, the malar bags are directly removed, and the incisions are hidden in the patient’s natural skin folds.

Which cosmetic eyelid surgery is right for you? The most appropriate approach depends on the specific lower eyelid features that you have, and the degree of sagginess of the lower eyelid bag. facial plastic surgeon, Dr. Buonassisi will assess your eyelid features during your surgical consult, clearly explain the pros and cons of each procedure, and recommend which approach is best for you.

Benefits of Malar Bag Excision

As we age, we begin to notice changes that contribute to an overall tired look. Upper and lower eyelids begin to sag and loose their firm texture. At the same time, fat deposits begin to bulge forward as the eyelid structures become lax. Lower eyelid laxity and puffiness contribute to an overall tired and aged look. In some case, excess laxity of the lower lid, caused by sun damage or genetics, becomes filled with fluid, making them noticeable. Following malar bag excision, your eyes will appear more youthful, rested and less puffy. The lower eyelid area will be more flat and smooth, and the lid skin will be tighter as it was when you were younger. More about The Science of Aging and Facial Changes can found in this website’s Knowledge Base.

How the Malar Bag Excision Is Performed

Facial Plastic Surgeon Dr. Thomas Buonassisi makes an ellipse shaped incision around the entire extent of the cheek bag.  The bag is completely removed. The incisions are closed with very fine stitches that are removed in one week. This surgery is ideal for older patients who have very noticeable festoons, and existing wrinkles in the cheek area. Dr. Buonassisi hides the incisions in the natural wrinkles of the cheek so that when they heal, they are virtually imperceptible. Malar bag excision typically takes from 1.5 – 2 hours, and patients can return home the same day.

Are You a Good Candidate

Malar bag excision in Vancouver is most commonly performed on people aged 50 years of age and older who already have wrinkles in the cheek area that can camouflage the incisions.

Physical Features

You may be a candidate for malar bag excision if you have any of the following physical features:

• Puffy often fluid filled bags on the upper cheek
• Loose skin of the upper cheek
• Existing wrinkles or folds in the cheek area below the eyes

General Health

You may be a candidate for malar bag excision if you are in general, in good health:

• You have normal blood pressure
• You are not taking blood thinners, or your physician could safely recommend that you discontinue them for 2 weeks
• You do not have significant dry eye syndrome
• Your eye health is otherwise normal

Benefits of the Surgery

• Tightening of the lower eyelid skin
• Reduction in the fluid filled pocket below the eye and lose skin of the upper cheek
• A more rested and youthful looking eye appearance

Recovery

Most patients describe the recovery period from malar bag excision surgery to be quite easy. There is typically no discomfort, aside from some slight itching where the sutures are placed. Swelling and bruising is at its worst on day three following surgery, and usually subsides two weeks following surgery. The following information will give you a sense for what kinds of activities are safe during the recovery period.

Time Off Work

• Most people who work in the public eye take one week off work
• One week after surgery, some people have perceptible swelling and bruising, which can last for another week or so – these signs are easily covered with makeup or glasses
• People who work from home are typically feeling good and are able to be back at their desks two days after surgery

Back to Normal Activities

• You can resume normal activities, such as light household work and taking a gentle stroll, the day after surgery
• You can resume light fitness activities, such as jogging or yoga, one week after surgery
• You can resume vigorous fitness activities, such heavy weight training or high impact cardio, two weeks after surgery
• You should avoid bending over and lifting heavy objects for two weeks after surgery

Restaurant Ready

• Once your sutures are removed seven days following surgery, you will typically feel “restaurant ready”, meaning that you would feel comfortable meeting up with friends – however, you will still have some evidence of swelling and light bruising, which can be camouflaged with makeup

Complete Recovery

• Most people are feeling quite comfortable being out in public without much evidence of swelling or bruising two weeks after surgery – makeup or glasses can be used to camouflage these signs
• The incisions, which are carefully hidden in the natural eyelid crease, fade over time, often becoming imperceptible within three months of surgery

Risks & Complications

All surgeries have associated risks. Dr. Buonassisi will review the risks and benefits of the surgery in detail during your surgical consult.

Combination Eye Procedures

Malar bag excision is often combined with other facial rejuvenation surgeries. Many patients opt to have their eyelids and other facial features, such as jowls and neck, treated at the same time in order to save having to take time off work and recover from more than one surgery. Malar bag excision is often performed with upper eyelid blepharoplasty, for patients who are dissatisfied with they upper and lower eyelid appearance and would like to have surgery just one. Malar bag excision is often combined with non-surgical treatments to smooth away lines and add youthful looking volume to the face.

Alternative Eye Procedures

Sometimes large bags under the eyes are caused by bulging fat pockets that extrude through lax lower eyelid skin. In this case Dr. Buonassisi may recommend Lower Eyelid Blepharoplasty Surgery. Blepharoplasty surgery does not treat wrinkles around the eyes, if this is a concern, Dr. Buonassisi may recommend BOTOX® treatments for the Crow’s Feet area, or the area between the eye brows.

What Eyelid Procedure Is Right for You?

While the information on this site is extensive, it is not designed the replace the skill and expertise of a board certified facial plastic surgeon. Use the information to help you explore the possibilities and educate yourself about the typical recovery period of cosmetic surgery. While this site provides general information about cosmetic surgery as it related to the average person, it cannot be used as a tool for people to decide which surgery is best for them. Only a thorough consultation with a board certified facial plastic surgeon can provide the specific information they require to make an informed decision about surgery. To find out which surgery is most appropriate for you, please Request a Consult.