Treatment of malar bags and festoonsMalar bags and festoons are swellings and hollows in the cheek and eye area. They are harmless, but have a negative impact on facial expression and are often perceived as aesthetically bothersome. With treatments such as fat-dissolving injections, high-intensity focused ultrasound (HIFU), or advanced techniques such as AccuTite, we reduce or eliminate the unwanted "pouches" – gently and tailored to your skin. Depending on the findings and the current condition of the skin, different methods may be considered.

The local anaesthesia (used with AccuTite™) ensures you feel nothing of the actual treatment. After the treatment, mild swelling or redness may occur, which typically subsides quickly.

The treatment typically lasts between half an hour and one hour, depending on the skin condition and the extent of the malar bags.

You will notice the first effects immediately; the full result becomes visible within a few weeks.

There are now very gentle and multifaceted treatments available for malar bags and festoons. At the practice of Dr. Schuhmann in Düsseldorf, we offer you the full spectrum of aesthetic options. These range from focused ultrasound to radiofrequency. For moderate or mild cases, effective treatment is usually possible without surgery. Modern techniques such as Morpheus8™ and AccuTite™ are particularly promising. They remove fat deposits within the skin very gently while simultaneously tightening the skin structure. The results are long-lasting and have a skin-rejuvenating effect.

Before any malar bag surgery, we will discuss in detail your wishes and expectations, and what can realistically be achieved with an operation, in order to obtain the best possible result for you. In the 14 days prior to surgery, you should not take any pain medication containing acetylsalicylic acid (e.g. aspirin). Blood-thinning medications should also be discontinued a few days before the procedure, in consultation with your GP, as their anticoagulant effect may delay clotting and cause post-operative bleeding. Please reduce your consumption of nicotine and alcohol to a minimum before the procedure. You should also avoid sleeping tablets wherever possible. Plan for at least one week off work following the operation. After two to three weeks, the post-operative swelling is generally no longer noticeable in public.

The procedure itself takes approximately 30–90 minutes. In most cases, you will receive a local anaesthetic together with a sedative. Malar bag surgery can also, in principle, be performed under general anaesthesia. Through a fine incision on the cheek, the excess subcutaneous fat tissue is completely removed. The facial musculature is tightened where necessary and any excess skin is removed. The scar "disappears" into the natural skin fold and is virtually invisible after a few weeks.

Post-operative pain following the removal of malar bags and festoons can be managed with simple analgesics such as ibuprofen. It is advisable, however, to cool the face during the first few days after surgery and to rest. Sutures are removed after 5–6 days. Due to possible swelling and bruising, social activities may be limited for approximately one week. You should also refrain from physical exercise for around three weeks. Visits to the sauna and sun exposure should likewise be avoided for four weeks.

Festoons and malar bags are frequently confused with under-eye bags. Under-eye bags, however, sit directly beneath the eye, whereas festoons and malar bags additionally appear below the under-eye bags or dark circles, over the cheekbone. To address festoons, malar bags, and under-eye bags, there are various treatment options available, including: laser, ultrasound, minimally invasive procedures (hyaluronic acid treatment, fat-dissolving injection), or surgical intervention.

In many cases, malar bags can also be removed without surgery. The swellings over the cheekbone are dissolved using a fat-dissolving injection. The fat deposits that are dissolved in this way do not return. Another effective treatment option is HIFU treatment or AccuTite™ treatment with Morpheus8™ Prime.

Under-eye bags are visible swellings beneath the eye – and should not be confused with malar bags. Under-eye bags are most commonly hereditary. The connective tissue becomes lax and the fat tissue beneath the eyes descends. What can be done about under-eye bags? Adequate sleep and a healthy, balanced diet can help. Cool compresses (gel pads) and chilled tea bags – preferably black tea – can help reduce the swelling beneath the eyes. For pronounced under-eye bags, surgical lower eyelid tightening (lower blepharoplasty) is often the only effective solution.

Artificial malar bags can be a consequence of unsuitable hyaluronic acid injections (wrong preparation, incorrect cross-linking) in the eye area, or a suboptimal injection technique. In the worst case, residual material can accumulate in the region of the cheekbone and cause swelling. At first glance, artificial malar bags are indistinguishable from naturally occurring ones to a medical layperson. Important to know: artificial malar bags can be prevented by an experienced practitioner and through the selection of the correct product.

We can remove artificial malar bags in almost all cases. Depending on the extent and the preparation used, we can dissolve the remaining hyaluronic acid with an enzyme (hyaluronidase). In some cases it may be beneficial to rebalance the tissue with additional treatments. Please book a consultation at one of our locations in Düsseldorf or Berlin.