Malar bags are noticeable bulges that appear on the upper cheekbones, often a source of cosmetic concern. These formations can disrupt the smooth contours of the midface, leading to a tired or aged appearance. Their development involves anatomical structures, aging, genetic predispositions, and various lifestyle and environmental influences.
What Are Malar Bags?
Malar bags appear as distinct mounds or puffiness on the cheekbones, directly below the lower eyelids. Unlike under-eye bags, malar bags are positioned lower on the face, near the top of the cheeks. They often form a crescent or semi-circular shape, creating a visible demarcation line. These formations are sometimes referred to as malar mounds or malar edema.
Malar bags differ from festoons, though the terms are sometimes used interchangeably. Malar bags involve chronic swelling that may include fluid and excess tissue. Festoons are a more severe presentation, characterized by cascading folds of skin and muscle that can hang over the upper cheek. They are often described as fluid-filled sacs that develop beneath the eyes and extend along the lower eyelids and cheeks.
How Mid-Face Anatomy Contributes
Malar bag formation is closely linked to mid-face anatomy, particularly the orbicularis oculi muscle, the orbital retaining ligament (ORL), and the sub-orbicularis oculi fat (SOOF) pad. The orbicularis oculi is a circular muscle surrounding the eye, and its fibers extend over the cheek. Laxity or weakening of this muscle can contribute to the appearance of malar bags.
The orbital retaining ligament (ORL), also known as the orbitomalar ligament, originates from the periosteum of the orbital rim and extends through the orbicularis oculi muscle to insert into the skin. This ligament acts as a supporting structure, defining the upper border of the prezygomatic space and compartmentalizing facial tissues. With age, this ligament can weaken or elongate, allowing tissues to descend and contribute to the formation of bulges.
The sub-orbicularis oculi fat (SOOF) pad is located beneath the orbicularis oculi muscle. This fat pad contributes to the contour and volume of the mid-face. When the orbital retaining ligament weakens, the SOOF pad can protrude or prolapse, creating the visible puffiness associated with malar bags. The interplay between the weakening of the ORL, the descent or herniation of the SOOF, and the action of the orbicularis oculi muscle collectively leads to the characteristic appearance of malar bags.
Aging and Genetic Influences
The natural process of aging impacts the structural integrity of the facial tissues, contributing to the development of malar bags. As individuals age, the skin loses elasticity due to the breakdown of collagen and elastin fibers, which are essential for maintaining skin firmness and resilience. This reduction in skin elasticity can lead to sagging and the increased prominence of folds and bulges in the lower eyelid and cheek area.
Connective tissues and ligaments in the face, including the orbital retaining ligament, also weaken over time. This laxity allows fat pads, such as the sub-orbicularis oculi fat, to shift or protrude from their youthful positions. Changes in facial fat pads, including both growth and atrophy in different areas, further contribute to the altered contours that can manifest as malar bags.
Beyond the universal effects of aging, genetics play a role in predisposing some individuals to malar bags. Some people are born with a facial anatomy or inherent tissue laxity that makes them more susceptible to developing these formations, often appearing at a younger age or running in families. This genetic predisposition means that even without significant aging, the underlying structural weaknesses can lead to the early manifestation of malar bags.
Lifestyle and Environmental Factors
External factors can exacerbate or contribute to malar bags. Chronic sun exposure damages collagen and elastin fibers in the skin, accelerating laxity and weakening connective tissues. This degradation can make the skin more prone to sagging and the formation of malar bags over time.
Smoking negatively impacts skin health, degrading collagen and elastin and impairing circulation, which can contribute to the worsening of malar bags. Fluid retention also makes malar bags more prominent, and factors like excessive salt intake can lead to fluid accumulation in tissues. High sodium levels can influence lymphatic function and fluid balance in the skin.
Allergies can cause inflammation and fluid accumulation around the eyes and mid-face, temporarily worsening malar bags. Lack of adequate sleep can contribute to puffiness and fluid retention, making more noticeable malar bags. These lifestyle and environmental influences can accelerate the development or increase the severity of malar bags, even in individuals without a strong genetic predisposition.