Malar bags: terminology, pathogenesis, and modern treatment approaches

Objective. To systematize current data on anatomical prerequisites, etiopathogenesis, classification, and correction of malar bags for optimizing treatment and improving effectiveness of aesthetic rehabilitation. Material and methods. We reviewed the PubMed, Scopus, Web of Science, Cochrane, and eLibrary.ru databases regarding anatomy, pathogenesis, and correction of malar bags. Analysis covered the period 1997—2026 with primary emphasis on studies published over the last ten years. The review included relevant original studies, systematic reviews, meta-analyses, and anatomical studies. Results. Malar bags are multifactorial and associated with anatomical characteristics of the midface (malar septum, orbicularis retaining ligament, and zygomatic cutaneous ligament), age-related tissue changes, redistribution of fat compartments, and impairment of lymphatic drainage. There are 3 main clinical forms: malar edema, malar bags, and festoons. Modern treatment strategies include conservative, minimally invasive, and surgical approaches, with the most stable results after surgical and combined treatment. Conclusion. Malar bags represent a heterogeneous group of periorbital deformities. Effectiveness of correction is determined by comprehensive assessment of anatomical features, clinical form, and dominant pathogenetic mechanisms. A personalized choice of treatment strategy and combined approaches improve predictability and long-term stability of aesthetic outcomes.