Malar mounds are distinct facial swellings that can cause cosmetic concern. While often mistaken for typical under-eye bags, they represent a separate anatomical issue. This article explains what malar mounds are, how they differ from other conditions, and their various management approaches.
Understanding Malar Mounds
Malar mounds appear as crescent-shaped areas of puffiness or a ridge located on the upper cheekbone below the lower eyelid. They can become more noticeable with certain facial expressions or when fluid retention is present. These swellings may affect one side of the face or both.
Malar mounds differ from under-eye bags. Under-eye bags typically result from the protrusion of fat or loose skin directly beneath the eye. In contrast, malar mounds involve a combination of fluid accumulation, skin laxity, and muscle weakness over the malar (cheek) bone, often involving the orbicularis oculi muscle and its retaining ligaments. More severe cases of malar mounds are sometimes referred to as festoons.
Factors Contributing to Their Formation
Malar mounds often develop from the weakening of fascial attachments and ligaments in the malar region, particularly laxity in the orbicularis retaining ligament and zygomaticocutaneous ligaments. The orbicularis oculi muscle, which surrounds the eye, also plays a role when its support diminishes.
The natural aging process further exacerbates malar mounds by reducing skin elasticity and the amount of collagen and other supporting tissues. As skin loses its firmness, it becomes less capable of holding the underlying structures tightly, making any swelling more apparent. Fluid retention can significantly worsen the appearance of malar mounds. Conditions such as allergies, certain medical issues, a diet high in sodium, or poor lymphatic drainage can lead to fluid accumulation in this area, often making the mounds more prominent, especially in the mornings.
Genetics also influence malar mound development, as some individuals are predisposed. Environmental factors, like prolonged sun exposure, can damage skin elasticity and weaken supporting structures. Smoking also negatively impacts skin health, accelerating the aging process and potentially worsening these mounds.
Approaches to Managing Malar Mounds
Managing malar mounds can be challenging, but various strategies exist, from conservative measures to professional treatments. Lifestyle adjustments can help reduce their prominence:
Staying well-hydrated.
Reducing sodium intake.
Ensuring adequate sleep.
Managing allergies.
Sleeping with the head elevated.
Topical treatments, such as creams containing caffeine or retinol, may offer temporary, modest improvements by reducing puffiness or enhancing skin texture. However, these products have limited effectiveness in addressing underlying structural issues. Lymphatic drainage massage can also help reduce fluid buildup.
Professional interventions include non-surgical and surgical options. Non-surgical approaches, such as certain energy-based devices like radiofrequency or ultrasound, aim to tighten the skin and underlying tissues. Injectables, like micro-Botox for muscle relaxation or carefully placed fillers to camouflage the depression below the mound, are sometimes considered. However, these require an experienced practitioner, as imprecise administration can worsen the condition.
Surgical interventions offer more definitive solutions for malar mounds. Lower blepharoplasty, often combined with malar mound excision, commonly targets excess skin, muscle, and underlying fat. Direct excision, which removes the mound, may be considered for severe cases but carries a higher risk of visible scarring. A midface lift can also address the broader cheek area, indirectly improving malar mound appearance by lifting and repositioning mid-face tissues. Consulting a board-certified plastic or oculoplastic surgeon is advisable for accurate diagnosis and personalized treatment recommendations.