Dear Doctors, Is it possible to get the desired result (not by volume, but by skin lift effect). I do not want to have more volume at the cheeks area. I do not want to add volume at all, but I can allow minimal volume to any areas, but cheeks (minimal cheeks volume is okay). Can I expect lift effect without adding much volume which I show at "desired" picture? Where and how injections should be done? Which is the most predictable option? Fat, hyaluronic acid or predefined implants?
Is It Possible to Get Desired Result? (photo)
Doctor Answers (11)
How to get the results produced by manual manipulation of your face
Options for Liquid Facelift
Face lift without surgery
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It is possible to get a very nice volume in most patients. You look like a perfect candidate for the liquid facelift. Often the cheek area is not the area to treat. Sometimes it is better to treat behind the cheek area as well as in front of the ears and temples. In your case, it looks like injections in the mid-face would lift the nasolabial folds. For volume, I prefer Radiesse and Sculptra injections. I would stay away from facial implants as they can have multiple complications, are permanent, and do not change as your face ages over time. This means you could end up looking very strange in later years. With facial fillers, you can have an excellent result if done properly by an experienced injector.
Facial Lift without Surgery
For my patients with similar requests, I would typically recommend what we call an UltraLift. This procedure uses Ultherapy, ultrasound technology, which provides subtle, non-surgical lifting and tightening of the skin; combined with Radiesse, which is a facial filler that provides immediate results by filling in the nasal labial folds. I would also recommend slight volume added to the mid face above the nasal labial fold which will lift and reduce the fold without significant increase in cheek volume. This tends to be very rejuvenating without making the cheek bones look more prominent. The nice thing about this combination approach is that the Ultherapy, takes about 8 weeks to see final results, while the Radiesse provides immediate results and lasts for about a year. I definitely would avoid implants as I don't think that will give you the results you are seeking. Good luck to you.
Facial lift without surgery
You are looking for a lift of the skin which is different from increasing volume. Fillers may help but you are correct in deciding not to over do the filling. Surgery would also help but you really do not have that much extra skin. You might consider a non surgical lifting of the skin with a procedure such as Exilis. This is a non invasive radiofrequency treatment that will tighten the skin a bit. It certainly does not do what a facelift does but in combination with a small amount of fillers you will get a good correction without scars or downtime.
Liquid Facelift vs. Surgery To Lift Cheek And Decrease NL Fold
Thank you for this excellent question. The answer is both.
The orbicularis oculi muscle surrounds the eye and goes down onto the cheek. A lower eyelid blepharoplasty, if appropriate, with a lateral orbicularis muscle sling will elevate the cheek, decrease the nasal labial fold and improve the lower eyelid all simultaneously without any increase in volume. If a blepharoplasty is not appropriate, a mid facelift is a bigger surgery that will accomplish many of the same goals.
Your desired after effect in your photograph shows an almost flat nasal labial fold. To accomplish this, I recommend a strong HA such as Perlane which is quick, simple and should last about one year.
If you wish to avoid surgery, cheek elevation can be accomplished with a filler such as Radiesse. However, this will increase volume.
To achieve "lift" without surgery, volume is required
Your desire not to add volume would make your desired effect quite difficult because it is the lack of volume that allows the face to "deflate" in the first place.
Sculptra can provide additional volume and can be injected more globally than HA fillers (plus it lasts much longer since the end result is your own collagen)
The placement of the product is the key - It's impossible to gauge the amount you would require from this minimal photo, but 1 or 2 syringes won't have much impact. Done correctly you would not have to worry about bulging cheeks - which is my guess of your major concern.
See a plastic surgeon or a good cosmetic dermatologist who specializes in fillers. That is where you will find your best answer.
Injectable fillers for facial enhancement
Injectable fillers such as hyaluronic acid, calcium hydroxlyapaptite, or autologous fat can aid in lifting the cheek; however, this is done by adding volume. The filler can be placed in a deeper tissue plane to minimize the added apparent volume. Implants can also be considered, but in most cases will add more volume than injectable fillers. Best wishes.
You will need to add volume in this area to achieve what you are looking for without a surgical lift. This may require anywhere between 3 and 7 cc's of filler. Fat is your best option. Implants are have shown unfavorable long term results in patients and HA is generally a poor choice for filling the cheeks with this amount of volume. Your typical HA syringe is between 0.8 and 1.0 cc and it does not last more than a few months. Consult a Board Certified Physician in your area that is familiar with fat grafting to further answer your questions.
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.