– Malar Bags After Long-Term HA Filler

Patient description

72 years old with no significant Pmh 

Case description

1. Patient under my care since 2022 for non-surgical facial rejuvenation.
2. Treated conservatively every ~6 months with HA fillers, mainly RHA (including RHA-4) for midface, cheek, jawline, and jowls.
3. History of keloid formation → surgical facelift not an option.
4. No prior complications over ~3 years with similar volumes and techniques.
5. Most recent treatment (~4 weeks ago): 2 syringes RHA-4 (midface) + 20 units Jeuveau to crow’s feet (placement documented).
6. 7 days post-treatment, patient developed clinically noticeable malar bags / malar edema.
7. Patient has baseline mild malar fullness and skin laxity, but filler had not worsened this previously.
8. No signs of vascular compromise, infection, or pressure-related complications; presentation consistent with malar edema.
9. Photos were self-taken and submitted by the patient; in-person evaluation pending (scheduled shortly).
10. Current working theory: multifactorial (progressive ligament laxity, skin laxity, and temporary lymphatic drainage changes from crow’s feet neuromodulator).

Proposed plan: conservative management — observation, allow crow’s feet Botox to wear off, avoid immediate filler dissolution.

Questions for the group:

• Can progressive skin laxity explain new-onset malar bags despite similar filler volume/placement over years?
• Do you agree with a wait-and-observe approach at this stage?
• In patients with skin laxity and keloid history, would early filler dissolution help or risk worsening hollowness?