Malar fat pads give the face its characteristic fullness at youth. We can recognize this area best as the cheek’s most pinchable spot. In younger people, the malar fat pads have high elevation.
Malar fat pads are spaces of subcutaneous fat you can find on your cheeks. They usually look worse as people age and are among the major reasons for midface sagging over time. The augmentation of malar fat pads is a crucial part of many facial rejuvenation processes, such as facelifts.
Malar fat pads are something that most people don’t concern themselves about in day to day life. However, these pads, which you can find in your cheeks, bear a lot of influence on your appearance, especially as you age. Despite them not being that well-known, many people find themselves plagued by issues with their malar fat pads at any age, though problems become commonplace after middle age. For some people, their malar fat pads become a source of insecurity, causing them to dislike their facial appearance.
Like any other facial feature, the malar pads can cause significant aesthetic problems for anyone, not just older people. Some people are more inclined to have issues with their malar fat pads due to genetics or certain lifestyle choices.
Now, malar fat pads are not a problem most of the time. They are just parts of the subcutaneous fat on your cheeks. However, certain factors and mechanisms such as aging make these pads stand out. Since balance and youthfulness are important in facial aesthetics, a very obvious malar fat pad can quickly become an issue.
The Anatomy of Malar Fat Pads
Malar fat pads, via their name, are pads of fat on each side of your cheeks. Subcutaneous fat has designations according to region and compartmentalization, and malar fat pads are partitions of the face’s fat spaces. You’ll find them in the lower portion of your undereye going down. The word malar may be familiar to you because another use of the term ‘malar’ is for the cheekbones or the malar bones. However, the two occupy different portions of the face, although they may overlap, such as in the cheekbones themselves.
The malar fat pad has a diagonal triangle shape that can go down until the nasolabial fold. In all of its entirety, it makes for a pretty significant aspect of the midface. The malar fat pad’s apex is at the malar eminence or the highest point of your cheekbones. The triangular malar pad base is at the nasolabial fold (Benoit et al., 2002).
The malar fat pad’s central location makes it a part of the face that can affect other features beyond just the cheeks. You’ll see in the following section on aging the extent of influence the malar pads have on the rest of the face.
Malar Fat Pads and Aging
Aging is the looming problem all of us have when it comes to facial aesthetics. The area of particular concern we have here is the midface, the malar fat pads’ location. As people get older, their face naturally tends to sag, something you may have observed in people in their 50s or 60s. The malar fat pads are the primary participants in this sagging. Over time, the malar fat pads go lower, contributing to the saggy appearance that comes with age. Note that a characteristic of a youthful face is a lifted appearance, which is why many facial rejuvenation procedures such as facelifts focus on elevating features to make them more youthful.
Apart from the natural sagging of these fat pads, there is also the issue of malar mounds or malar bags showing up. These mounds appear because of the natural sagging of the face that reveals the malar fat pads in an unattractive fashion. However, it’s not only the sagging of the face that causes this. Some people naturally have problems with how their malar fat pads look or how they take up space in their cheeks.
According to this study by Chia et al. (2010) on malar fat pad repositioning, the aging of said fat pad occurs on two distinct levels. The first one has to do with the upper level of change, meaning it occurs nearer to the surface. The researchers mention the ptosis of the fibro adipose layer attached to the skin as the primary cause in the study. An easy way to describe that would be the sagging of a fatty layer of the face. While this level of change may be the one most familiar to us, a deeper level of change also causes the aging effect on the malar fat pads.
The following are some facial features that malar pad aging might affect.
Let’s recall that a significant portion (the base) of the malar fat pad rests on the nasolabial fold. You may also know this as the line running from the outside of your nostrils down. Again, the malar fat pad is a pocket of fat. As the malar pad goes down, this pocket of fat makes the nasolabial fold much more prominent. It’s helpful to imagine the fat pad as a pouch that starts falling very slowly and starts putting pressure down on your nasolabial crease, and creates a significant bulge. This effect is why you often see older people with very prominent nasolabial folds.
The improvement of the nasolabial fold is one of the focal points of facial rejuvenation. We associate youthfulness with the lack of lines and smoothness, so a very prominent nasolabial fold will significantly impair a youthful appearance.
However, the nasolabial fat pad can also be enlarged in certain people due to genetics, creating a chipmunk cheek effect. Aging and gravity have little effect in these cases.
However, improvement of the nasolabial folds doesn’t necessarily require surgery. They often do not (Wollina et al., 2017), as facial fillers already do a good job at improving the nasolabial folds.
Another facial feature that the malar fat pad influences is the lower eyelid. Just like with other facial features, eyelids slowly sag as people age, and this sagging makes a person look older, more tired, and less attractive. As the malar fat pad sinks with aging, it also leaves a gap beneath the lower eyelid where soft tissue should be soft.
This gap eventually accentuates eyebags. Instead of bunching up like in the nasolabial fold, the lower eyelid area will look sunk. Over time, this will result in a skeleton-like appearance. It will contribute to a descending lid-cheek interface. Paired with the drooping features, you get a face that looks more aged.
Why Does the Malar Fat Pad Go Down Over Time?
We’ve established that the malar pads generally follow gravity as a person ages. But what are the mechanisms that cause this?
According to De Cordier et al. (2002), gravity is the main factor that causes the eventual ptosis (sagging) of the facial soft tissues, malar pads included. Of course, it’s not just the malar fat pads that eventually droop over time; many parts of the face do as well. However, it isn’t gravity only in the sense that some force is pulling on your malar fat pads. It’s more like the general wear and tear that your soft tissues go through over decades of use, such as running.
Because this downward motion is an essential aspect of aging, we now associate it with older people or aging in general. Given that, the most sensible approach to facial rejuvenation or achieving facial youthfulness is to tap into the vertical elevation of these sagging features.
Another thing that may cause the eventual decline of malar fat pads is the stability and hold of the ligaments in place. Yang et al. (2012) examined ten cadavers to observe the effects of aging on the malar fat pad. Their research concluded that six fixation ligaments are connecting the malar fat pad and deeper tissue. According to the researchers, the lack of support from these ligaments causes the malar fat pad’s descent.
Of course, the reason for malar fat pad aging is not ligaments or gravity alone. Instead, it is the combination of both that facilitates the decline.
Malar bags or mala mounds are bulges on your cheeks that often resemble eyebags or at least something close to eyebags. However, they aren’t exactly under the eye area but are more to the side.
In several cases, the problem with malar fat pads does not come from aging. Some people have malar bags or malar mounds even if they are still young or in their middle ages. Many people usually have malar bags together with undereye festoons, and in many cases, people use these terms interchangeably. However, malar mounds are not the same as festoons.
Some people tend to have obvious malar fat pads, and there’s a genetic aspect to that, not just aging in itself. However, aging could also worsen the situation and make the effects more prominent.
Malar bags may not have much to do with the composition of the malar fat pads. When malar bags occur, it’s usually due to several things that aren’t necessarily concerned with the malar fat pad. In many cases, malar bags are genetic, and they just look like that. In others, there may be fluid build-up due to sinus problems, smoking, or too much fluid retention, causing some build-up in the malar area. In several other situations, a significant change in body fat percentage should make malar bags more prominent.
To sum it up, malar bags often appear near the malar region, but they are not always related to malar fat pads. Take note; this does not mean that malar bags have nothing to do with malar fat pads. It’s just that the fat pads are not solely the only reason for them. If the fat pads were the only consideration, most facelifts would treat malar bags, given the amount of participation malar fat pads usually have in facelifts.
Unfortunately, that is not the case at all. Malar bags are one of the most complicated to resolve because there are many possible reasons for them. At this point, there’s no singular and straightforward approach to treating malar bags. However, that isn’t to say that treating malar bags isn’t possible, just that it takes a lot of consideration.
Malar Fat Pad Surgeries
Because the malar fat pad is a major aspect of the face, being on the midface, many methods have attempted to treat them over the years. Different practitioners have various methods that they choose to employ. The method best suited for certain patients depends on their specific circumstances.
Malar Fat Pad Elevation
The most popular way to improve the malar fat pad is through malar fat pad elevation, and there are many techniques to do it. Essentially, it’s just elevating the malar pad to consequently lift a part of the midface. According to the previously mentioned study by De Cordier et al. (2002), malar fat pad elevation is a pretty safe way to conduct or facilitate facial rejuvenation of the midface.
De Cordier and his associates reviewed 472 malar fat elevation accounts and analyzed their effectiveness and reliability to render a face more youthful. According to them, employing malar fat pad elevation to rejuvenate the face is a quite straightforward and standard way of doing so. The elevation’s main benefits are softened nasolabial folds, a reshaped malar eminence, and a rejuvenated lower eyelid.
The idea of malar fat pad elevation isn’t just for the cheeks themselves, though. Like we’ve previously established, the malar fat pad changes a lot in the face. In the late 1990s, Owsley and Fiala (1997) were the first ones who suggested that the craniolateral movement of the fat pad will improve the nasolabial fold.
In a smaller study on malar fat repositioning, Chia et al. (2010) focused on a simple technique using sutures employed at various locations to facilitate a volumized midface. The researchers claim that it is the existence of multiple traction points that allow for such a simple technique to yield good results. In their small cohort of 10 participants, there were no reported major complications.
Presently, people are still exploring different ways to elevate or suspend the malar fat pad. A common denominator between many of the existing studies is that they agree that elevating the malar fat pad is a simple and effective way to improve the area.
Malar Fat Pad Liposuction
Less common than malar fat pad elevation is malar fat pad liposuction. Since the malar fat pad is subcutaneous, some practitioners choose to use liposuction as their augmentation method. However, it is much less common than malar fat pad elevation and much less researched.
Take caution when you are looking towards liposuction to improve your malar fat pads. An experienced professional in malar fat liposuction is the best person to do the job.
Usually, surgeons have to use a small cannula and then perform the liposuction as performed regularly. Malar fat pad liposuction is best for patients who have issues with malar bags or mounds. However, treating the midface requires an in-depth understanding of the patient’s circumstances, so make sure to talk it through with your surgeon.
The Role of the Malar Fat Pad in Facelifts
As previously mentioned, augmentation of the malar fat pad is crucial in most facial rejuvenation procedures, such as facelifts. Because the malar pad is a prominent part of the midface, it helps a lot to adjust and elevate it through the several means mentioned above. When there are successful changes made to the malar fat pad, these changes translate to several other positive changes, such as less prominent nasolabial folds and a perkier lower eyelid.
The thing about the midface is that it’s an area where it can be challenging to achieve a consistent improvement. Many studies, such as the one by De Cordier mentioned above, note this particular difficulty. As a possible and effective solution to many problems that deal with aging in the midface, malar pad augmentation is a good way to go.
Ideally, facelifts should uplift the face and not sweep it backward, which is crucial to create a natural-looking, rejuvenated face. Many facelifts go wrong because they look unnatural, or it looks clear that the patient went through surgery.
Still, malar elevation or suspension is not the only procedure that comprises a facelift. It is only a part of an overall facial rejuvenation procedure. However, it does make the process relatively easier.
In many of the studies mentioned above, the researchers’ attempts to augment the malar fat pads often happen in facial rejuvenation procedures. The main purpose of malar fat pad elevation and suspension presented in scientific literature is to improve facial youthfulness and rejuvenate an aging face. The malar fat pads play a major role in facial rejuvenation procedures, including facelifts.