Question: I have swelling under my eyes. Although it is worse when I wake up and seems to create creases over my upper cheek, it never seems to go away. Is there an effective treatment for this problem?
Answer by Dr. Anita Mandal: Patients often confuse under-eye hollowing with lower-lid fat bags, malar creases, and malar bags.
■ Lower eyelid bags actually come from fat that surrounds the eyeball. This fat is normally held in place by fascial connective tissue. As we age, the connective tissue loosens, causing fat to protrude outward, resulting in the appearance of eyelid bags. Treatment for lower-lid fat bags is typically surgery and is known as blepharoplasty. When loose eyelid skin is present, skin is removed at the same time.
■ Lower lid hollows are the result of volume loss along the lower half of the eye socket which is, in actuality, the upper rim of one’s cheekbone. Treatment typically involves injectable, fillers, including temporary hyaluronic acid products such as Restylane, Juvederm and RHA collection. A popular long-term option is hyper-dilute Bellafill, the filler that last 5 years. In the presence of intermittent fluid retention, hyaluronic acid (HA) fillers can make the situation worse since HA’s work by attracting water. A bio-stimulatory injectable such as Bellafill, which stimulates collagen production, is preferred.
■ Some patients complain of creases that extend across the upper cheek. These grooves are known as malar creases. In some cases, swelling above or below the cheek creases can present as malar bags. Both malar creases and malar bags are often the result of changes in the malar ligament which originates from the malar cheek bone to insert onto the cheek skin. Treatment includes injectable fillers, RF micro-needling, laser resurfacing, surgery and/or combination of therapy.
■ The lower eyelid/ upper cheek zone is prone to fluid retention. Intermittent swelling that is worse in the morning and goes away as the day passes can also be due to salt retention, environmental allergies, or pooling of lymphatic fluid.
Many patients are not familiar with the anatomic differences between eyelid and malar cheek aging and tend to lump them all together. In order for treatment to be effective, it is important that your plastic surgeon properly identify the cause of the concerns. Treatment of eyebags is markedly different from that of eyelid hollows and malar creases.
Dr. Anita Mandal is a double Board Certified Facial Plastic Surgeon who specializes in facial rejuvenation, cosmetic surgery and non-invasive body contouring. On the medical staff at Jupiter Medical Center, her on-site offices' house surgical and laser suites. Dr. Mandal’s expertise lies in giving natural results and defined contours using the latest, most advanced techniques.
