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Question 37#

The following is true in relation to ‘malar bags’ or festoons:

A. Interestingly, they are hardly ever seen in smokers
B. They should be excised directly with minimal margins
C. There is no accepted and routinely successful treatment
D. They can be treated with minimal-skin-excision lower lid blepharoplasty
E. They can be significantly improved by a combined course of steroids and diuretics, but only in patients under the age of 40, without comorbidity, and for a maximum period of 4 weeks

Correct Answer is C

Comment:

There is no accepted and routinely successful treatment. Prominence of tissue and skin folds can occur in the malar region with ageing, but in some patients these may present as proliferative skin folds. Lower lid blepharoplasty will not help this condition, which is commoner in smokers. Direct excision is rarely satisfactory and leaves unsightly scars in prominent areas. One approach that can help is subcutaneous dissection and redraping combined with a subperiosteal cheek lift. 

References:

1. McCord CD, Codner MA. Eyelid and periorbital surgery. St Louis, USA: Quality Medical Publishing Inc., 2008.