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Q:

I have malar edema. Is it fixable? 3 surgeons in Florida say no?

A:

Hello and thanks for posting.

Malar edema is also known by the name malar bags or festoons. It is a very common problem and many people develop malar edema simply as a feature of facial aging.
However, malar edema is also a known complication of facial aesthetic procedures, especially facial fillers used in the under eye and cheek region. I have also seen patients who developed malar edema after facial procedures that produced significant facial swelling. I have seen it develop in patients after deep laser treatments, facelifts, and deep chemical peels where swelling was an issue.
In most cases, malar edema after treatment with facial fillers is temporary and will resolve with time. In situations where someone has preexisting malar edema it usually returns to baseline over time. But not always. Some people develop malar edema that is persistent.
So what to do?
The first treatment should always be direct compression of the region. Malar edema represents lymphatic fluid that has migrated into the subcutaneous space. By directly compressing the area of malar edema for about 10 seconds, several times per day, this will speed resolution of the edema in many cases.
Another option is to use Ultherapy in the upper lateral cheek and temple region. This energy based procedure leads to tightening and lifting of this region and the tissue elevation put traction on the area of malar edema and improves the appearance.
An additional therapeutic choice is to use either facial filler or PDO threads in the areas just adjacent to the malar edema to disguise or camouflage the problem.
Surgery or laser surgery is another option, but reviews are mixed because of the potential for scarring.

I hope that this information helps and best of luck to you!

Regards,
Dr. Pierone

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