Malar Bags: Can Lipofilling Help?

Malar bags (also called zygomatic bags or SOOFs) are a fat pad located between two ligaments (to put it simply, roughly at the border of the lower eyelid and the cheek area). Tissue fluid can accumulate there due to impaired lymphatic drainage. Whether this will happen or not depends on the individual anatomical structure. It is also impossible to predict in advance which surgery or procedure will eliminate or at least noticeably smooth out SOOFs.

How much can lipofilling help in the fight against SOOFs?

It is very important not to injure the malar bag, since it acts as a kind of fluid collector in the face, and if damaged, swelling in this area can persist for a long time. However, the malar bag itself is often the reason why patients seek treatment, so naturally, work is performed with it—or more precisely, around it.

During lipofilling (the transfer of the patient’s own fat tissue from one area to another) of the zygomatic area, the zone of the malar bag is always involved, but the bag itself is not damaged. By using the plasticity of fat as a sort of filler, the surrounding tissues can be raised to its level. The entire area around is evenly filled, with slight filling performed both below and above the bag.

During preoperative marking, the malar bag is outlined, and during the procedure the filling is carried out beneath it—on the supraperiosteal level and, if necessary, subcutaneously. The entry points for the cannula are also placed so that the main movements do not pass through the malar bag. If this is done technically correctly, the bag does not swell and is well camouflaged.

However, lipofilling only camouflages the malar bag, nothing more. Often this is a temporary measure, since lipofilling does not address gravitational changes, i.e. ptosis, but only adds or restores lost volume.

The result of lipofilling will be positive in the absence of ptosis, with good skin tone and turgor of the face.