I am 42 y/o. I have deep dents in my upper cheeks. Best way to deal with the dents: (a) dermal fillers (and what brand), (b) mini-facelift (what type) or (c) other? Thanks
Deep Upper Cheek Dents - Fillers or Facelift?
Doctor Answers (16)
Cheek Dents May Respond Well To A Combination Of A 3D Vectoring Lift in the Crow's Feet Area & Fiiler
Malar Bags, which may appear as "cheek dents," generally manifest toward the outside, upper portion of the cheek area. Multiple factors may contribute to their development, among them the natural volume deflation and sagging that comes with aging and drainage problems in the small lymphatic vessels in the region. Owing to the latter, anything that affects fluid dynamics, like allergic reactions, fatigue, excessive salt consumption, etc. may worsen the appearance.of malar bags.
While malar bags are generally difficult to treat, sometimes, the restoration of volume, using a volumizing filler, such as Juvederm Ultra Plus XC judiciously injected in a 3D Vectoring pattern on the sides of the eyes, helps to pull upward and straighten the area immediately below and medial to it lessening the overall appearance of the dents. To pre-assess the potential benefit of this approach, your physician may try pulling the skin upward and outward to see if there is improvement.
Additionally, I have found that superficial placement and molding into place of small amounts of Belotero Balance, a hyaluronic acid filler, along the "dent" helps to elevate line and permit a more natural, rounded contour. The benefit of Belotero is that even when superficially injected, as typically needs to be done for this situation, it does not result in the Tyndall effect, a bluish discoloration of the skin due to light scatter often seen with other hyaluronic acid-based fillers when injected too high up in the skin.
I have generally found that this combination approach of superficial filler, particularly Belotero Balance, injected directly into the dent, and 3D Vectoring Lift of the crow's feet area to produce the most gratifying aesthetic improvement for cheek dents..
Fixing deep upper cheek indentations
To fill out the indentations you show & describe, I would first try a hyaluronic acid filler such as restylane, perlane or juvederm because they are safe and easily reversible. You likely would be quite pleased with this. Eventually, you may also consider a longer lasting filler like radiesse, although there is no antidote to it so make sure an experienced specialist like a dermatologist is injecting you. Surgery is not ideal for a volume loss/indentation issue; surgery would be more optimal for sagging and looseness of skin.
Deep upper cheek dents
A facelift is not designed to fill out cheek dents, especially close to the nose. The goal of a facelift is to tighten jowls at the jawline and sagging tissues in the neck. Cheek implants are a better option to fill out any depressions or weakness in the cheek area itself.
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The dents are secondary to sagging of the cheeks. I will not make a specific recommendation because I cannot see your entire cheek in the picture you submitted, but I will provide a couple alternatives. Fillers such as Radiesse and Juvederm or fat augmentation of the "dent" will camouflage the undesirable cheek contour. If there is excessive fullness of the lower cheek and a deep groove between the nose and the corner of the mouth, I would suggest a cheek lift which will provide longer lasting improvement.
Malar Mounds treated with a Cheek Lift or Mid-face Lift not Fillers: See a Cosmetic Plastic Surgeon for Surgery
Malar mounds are indicative of midface or cheek aging where the lower border of your eyelid muscle is revealed as the cheek pad falls off of it. This may be secondary to lengthening of the structures that hold these structures in place. It is interesting to read the responses to your question where most responders want to fill this area! The reason being this is a nebulous and confusing region for most practitioners including plastic surgeons and facial plastic surgeons who have difficulty handling this region surgically. The treatment I would recommend would be surgical and not non-invasive if you could tolerate the down-time. It would involve lift ing the cheek and tightening the lower eyelid muscle through the lower eyelid or with an endoscope. This is referred to a mid-face lift or cheek lift. Practically speaking it would be replacing these structure to their proper position not just adding volume to the area. The longevity of surgically repairing this area is more and likely less expensive over a period of time.
I hope this helps.
Try fillers before surgery for your cheek "dents"
Agree with the comments of my colleagues. Restylane, Perlane, Juvederm should do nicely here but must be injected carefully. Radiesse is another option that works well for cheek augmentation. However, it needs to be placed more deeply than HA fillers and would likely have less effect on your problem area.
Stephen Weber MD, FACS
Fillers or Surgical Lift For Correction of Mid-Cheek Groves
Temporary fillers are an excellent first choice to fill in creases due to the early signs of facial aging. The photo you have provided shows mid-Cheek groves which develop with mid face decent. Fillers are a non-surgical means of softening these creases with minimal down time. Juvederm or Restylane work equally well. The results should last about a year. The procedure can be done in the office with topical anesthesia. Some bruising may occur.
Another alternative is a mid face or a cheek lift. A photo of your entire face would be helpful to determine how much you would benefit from these procedures. If you have jowls or fullness in the lower part of you face, this may be a better long-term option.
I would recommend a consultation with a Board-Certified Plastic surgeon. Best regards, Andrew Lyos MD, FACS
Your upper cheek grooves may benefit from Injectable Fillers.
I reviewed the photo you posted. You have upper cheek grooves that are fairly common. These respond well to Injectable Fillers. My personal preference is Silikon-1000 for permanent results.
Treatment options for malar bags
Your photograph shows prominence of something we call malar bags. This is a triangular fat pad the can become prominent when we age. The dents you see are the depressions in the tissue around the prominent fat pad, which develops as the midface descends due to aging..
There basically two options to treat these bags. One is surgery, which involves a lower eyelift (blepharoplasty)and midface lift with resuspension of the fat pad. It is a lot to go through to fix a relatively minor problem. Your other option is fillers. In my experience, Restylane would be the best filler to camouflage the prominent fat pad. It's a little tricky to do to get a nice result, so make sure you see a physician who has experience with this type of injection. You will likely be very pleased with the results, and the improvement will probably last a year, or so.
A full face picture would be best to give you specific advice. However, from what I can see, fillers would likely be your best option. Popular fillers would include Radiesse, Juvederm and Sculptra. In consultation with your plastic surgeon, you be able to choose which filler you would like to try. I agree with everyone that you should avoid permanent fillers such as silicone. Good luck.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.