Malar Edema: Causes And Treatment

In this article, we will take a close look at malar edema, a condition characterized by swelling in the cheek area. We will explore the various causes of this condition, including the use of dermal fillers, inflammation, systemic diseases, and angioedema. We will also discuss the different treatment options available, and whether malar edema can be completely resolved.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

A blue image with text saying "Malar Edema"

What is malar edema and what are its causes?

Malar edema is the medical term for swelling in the cheek area. One of the most common causes is the hyaluronic acid filler which gets injected around the eyes. The dermal filler puts pressure on the fluid-draining system, obstructing the outflow and leading to edema [1].

Another cause of malar edema is inflammation around the eyes. It causes a fluid buildup as water is drawn from the blood to the inflamed region [2]. Among the possible causes of the inflammation are:

  • rosacea,
  • lupus,
  • seborrheic dermatitis,
  • photosensitivity reaction,
  • erysipelas,
  • cellulitis,
  • dermatomyositis [3, 4].

In certain people, the anatomy of their malar septum can lead to the development and progression of malar edema. The malar septum is a structure below the eyelid that can cause accumulation of water and hemoglobin above it [5].

Sometimes, malar edema can be a symptom of systemic diseases. Illnesses that can lead to malar edema include thyroid disorders, infections, allergic reactions, heart and kidney disease, and cancer [6].

A causative factor for malar edema can also be angioedema. It is a deep swelling in the skin. Angioedema is most commonly caused by allergic reactions or as a side effect of ACE inhibitors [7].

What is the treatment for malar edema?

Malar edema is characterized by persistent puffiness in the space below the eyelid and above the cheek. The treatment of malar edema is often complex. This is due to its multiple causes and development processes. Also, the severity of the edema itself determines the therapeutic approach.

One of the primary treatments for malar edema is surgical intervention. Multiple techniques can be used such as the midface lift, subciliary skin-muscle flap, the release of the orbicularis retaining ligament and zygomatico-cutaneous ligament, canthopexy, and muscle suspension [8].

In patients with malar edema caused by hyaluronic acid filler, a dissolving enzyme is injected. During a short injection, up to 0.5 ml of hyaluronidase is given below the skin to get rid of the dermal filler [9, 10].

Another management option is fractional microneedle bipolar radiofrequency combined with a medium-depth 15% trichloroacetic peel. This is a safe and effective treatment for malar edema [11].

Can malar edema be treated?

Malar edema can be treated. However, whether it goes completely away depends on what causes it and what its management looks like.

In some cases, malar edema can be resolved with appropriate treatment. For instance, malar edema caused by hyaluronic acid obstruction can be effectively treated. The effects after the enzymatic therapy are quickly visible. The procedure has a low risk of complications [9].

In addition, surgical treatment of malar edema in patients with predisposing anatomy can be well managed. Out of 89 patients who underwent surgery, only around 15% had persistent malar edema [8].

Patients with malar edema should be aware that it can be a persistent condition meaning it can require multiple operations and treatments. Sometimes, malar edema can resurface even after successful treatment.

For example, research found that the results of therapy for edema owing to tear-trough augmentation were permanent, but malar edema returned after two to three weeks [10].

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Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.