THE GUTHRIE GUIDE • Expert Answers from dr. ashley guthrie
What Is Malar Edema? Dr. Guthrie Explains This Common Under-Eye Swelling
DR. GUTHRIE EXPLAINS
A Swelling That Looks Like an Eye Bag, But Isn't
In this video, Dr. Ashley Guthrie breaks down malar edema, a type of cheek and under-eye swelling that can be mistaken for a traditional eye bag but behaves very differently and requires a completely different treatment approach. She explains what causes it, why it can fluctuate day to day, and why surgery alone will not fix it. View the full video transcript below.
key takeaways:
- Malar edema is a buildup of fluid that can resemble under-eye bags.
- It is often associated with filler and impaired lymphatic drainage.
- Swelling may fluctuate due to salt, alcohol, allergies, and other factors.
- Treatment often includes dissolving filler, skin tightening treatments, and lymphatic massage.
- A traditional lower blepharoplasty alone will not correct malar edema.
VIDEO TRANSCRIPT
In Dr. Ashley Guthrie's Words
On what malar edema is:
"What is malar edema? Malar edema, also known as the bane of our existence as facial plastic surgeons, is an area of swelling that happens at the top of the cheek that can masquerade as an eye bag."
On what causes it:
"The cause is not always able to be discovered, but it's frequently caused by filler treatments in the cheeks or in the lower eyelids. What it is, is basically a blockage or an obstruction in lymphatic flow in the face, and this leads to a buildup of fluid in that area."
On why it can look different day to day:
"You may notice that they look better on some days and worse on other days, especially if you've had a lot of salt, or you've been having alcohol, or you're having some seasonal allergies. All of the things that can lead to just generalized fluid retention in your body."
On the overall treatment approach:
"The treatment for these is challenging, but primarily revolves around a combination of things to try to relieve that obstruction and shrink those underlying tissues."
On dissolving filler first:
"After dissolving filler, which is an absolute must if we think that that's playing a role or it was the original culprit of the issue, the most successful treatment tends to be a combination of radio frequency micro-needling like Morpheus8, with or without laser treatments like CO2 laser."
On at-home and lifestyle measures:
"Lymphatic massage can also be helpful, and that's something that can be done right at home by you on a daily basis. Keeping well hydrated and reducing salt and alcohol intake may also help."
On why surgery alone won't fix it:
"The biggest thing to know is that these will not go away with a traditional lower blepharoplasty, because they are not fat pads and they are not excess skin. It is actually a buildup of fluid."
MALAR EDEMA
Frequently Asked Questions
What is malar edema?
Malar edema is swelling at the top of the cheek, just below the eye, that can look similar to an eye bag. Dr. Ashley Guthrie explains that it is caused by an obstruction in lymphatic flow that leads to fluid buildup in the area, rather than excess fat or skin.
What causes malar edema?
Dr. Ashley Guthrie notes the cause isn't always identifiable, but it's frequently linked to filler treatments in the cheeks or lower eyelids, which can disrupt normal lymphatic drainage in the face.
Why does malar edema look worse some days than others?
Because malar edema is fluid-related, it can be worsened by factors that cause generalized fluid retention, such as high salt intake, alcohol, or seasonal allergies, according to Dr. Ashley Guthrie.
How is malar edema treated?
Dr. Ashley Guthrie explains that treatment starts with dissolving any filler that may be contributing to the problem, followed by a combination of radiofrequency microneedling (such as Morpheus8), sometimes paired with CO2 laser treatments. Daily at-home lymphatic massage, staying hydrated, and reducing salt and alcohol intake can also help.
Can a lower blepharoplasty fix malar edema?
No. Dr. Ashley Guthrie is clear that a traditional lower blepharoplasty will not resolve malar edema, since the swelling is caused by fluid buildup rather than excess fat pads or skin, which is what that procedure addresses.
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Dr. Ashley Guthrie is a board-certified facial plastic surgeon at Guthrie Facial Plastic Surgery in Brentwood, Tennessee, serving patients throughout the greater Nashville area.
