Traditionally, Lower eyelid bags & hollows were treated by taking out the bags or fat under the eyes. This reductive type of approach has dominated the past 100 years or so in plastic surgery thought. Within the last 10 years or so a volume replacement approach has started to dominate our thinking. Now plastic surgeons & dermatologists are now using volume to fill in the transition from the eyelid to the cheek. Fillers like Restylane®, Juvéderm®, Perlane, Belatero, etc are being used below the bags to help fill in the transition. Long term options include fat injections, facial implants and The YoungVitalizer, The Incision Less Facial Rejuvenation Procedure.
The Malar Mound, in the video below, is the presence of the orbicularis oculi muscle overlying the attachment of the smiling muscles (click here for the facial muscles anatomy). The Lower Eyelid Lift has been used to help this along with a midface lift. The results can be subtle to moderate. Filling the deep part of the cheek is another approach. This can be done with Fillers like Restylane®, Voluma™, Juvéderm®, Belatero, Perlane, etc. You can also fill this area in with fat injections or the YoungVitalizer, The Incision Less Facial Rejuvenation Procedure. In the video below, another option is presented. In this approach the malar bag mound is cut out directly (excision is another term). We incorporated a geometric line closure to hide the incision better. In terms of filler, in short, Restylane® is good for around the eyes because it is more accurate in its placement and subsequent volume filling. Juvéderm® is good for volumizing as it pulls in more water. Juvéderm® is good in the deep cheek and some of the bigger folds but we don't recommend it in the eye region. Perlane is also much like Juvéderm® in our experience. Belatero is supposedly good around the eyes because it is even less volume pulling like Restylane® and spreads better. In our experience, Belatero has not been used as long as Restylane® and since we have had good success with Restylane® we tend to choose this product for the region around the eyes. Voluma™ is even more volume producing like Juvéderm®.
Sculptra is a longer lasting filler. This suture material is converted to co2 and water. In the process, the inflammation and breakdown of the sculptra creates collagen and the volume that we are striving to create.
Cheek Fat Injections - A Natural Long Lasting Cheek Filler for Cheek | Midface Lifting: