I think that 2 syringes would be a good starting point. I typically inject 3 syringes for the cheeks. I typically break the cheek down into 4 zones. As a trainer selected by Allergan for this product in the New York area, I have found that initially physicians need to use more product due to their injection technique. With experience, they learn to place the product in key supporting strategic areas in the cheek requiring less product with superior results.
Zone 1: outer cheek bone, this area is emphasized more with women. You could benefit from enhancement here, more on the right side vs. the left.
Zone 2: mid portion of the cheek bone. On the left, you only would need minimal enhancement, more so on the right.
Zone 3: this area gives us the apple cheek. this part of the cheek is the portion under the eye. It appears your surgeon augmented this area already with fat more on the left. You could benefit from a little Juvederm Voluma on the right side, about .2 cc.
Zone 4: also known as the sub malar zone. This is the lower part of the cheek. Here too you have adequate volume.
One area you didn't mention in your question- the temples. I will often fill the temples with Juvederm Voluma to give a more natural and youthful appearance. All too often, when only the cheeks are treated, the hollowness in the temples becomes accentuated. You would benefit from 1 syringe (half per side) in the temple area. Other areas (off label) that I will use Juvederm Voluma is along the jaw line and chin.
In summary, based on this analysis, I think two syringes would be adequate and I would use 1.25 syringes on the right and .75 syringes on the left.
I find it helpful for patients to bring in pictures of themselves from 5, 10, 15 and 20 years ago so as I can analyze. This can help demonstrate where and how much volume has been lost. This is combined with 3D computer imaging to see what kind of change can be accomplished naturally.
Good luck with your treatment.
Ran Y. Rubinstein, MD
Board Certified Facial Plastic Surgeon
Assistant Clinical Professor New York Presbyterian Hospital
Trainer, for Juvederm Voluma
First off, your cheeks look great! I understand the desire to have the rounded fuller cheeks however, so I do agree that Voluma would be a good option for you. My philosophy is to start slowly and inject more as needed. I would recommend one syringe initially, then possibly one more at your follow up visit. Remember you don't want to look "done" - and you certainly look much younger than 57!
As you can tell from the answers on here, there is a great deal of differing opinions in the amount you will need. So I will add to that. My approach is to always give a natural adjustment. I don't want patients to look "different", more "enhanced versions" of themselves. I personally, would inject 1 syringe split between both sides, and then have you come back in 2 weeks to see if another would be needed. At max I would think you need 2 syringes total.
"This answer has been solicited without seeing this patient and cannot
be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."
In general, it is not easy to predict how much volume is necessary as a lot depends on how much the first syringe accomplishes and your desires. Less is more. You don't want to look like a freak or a plastic surgery junkie. There are no cook books to filler injections.
If it were obvious by your pictures or desires that you need more than two syringes of Voluma, you would be better off using Sculptra, which would give you 8 ccs of volume and be more cost effective.
it is difficult to predict how much Voluma you will require without seeing you but we typically advise patients 2 syringes initially in each cheek and then follow up again in 2 months with consideration for another 2 syringes.
A syringe of Voluma goes a long way in our clinical practice. However, you may desire increased enhancement near the zygoma and cheek bones which will require additional filler.
Thanks Missy for the question and photos. It looks like you have achieved a nice result from the fat grafting to your cheeks. Voluma would be a nice enhancement. One of the real advantages of Voluma is that you see the result of the injection immediately. This way you can use as much or as little as is necessary to achieve the result you seek in a single visit to your experienced board certified injector. Since you liked the initial result of the fat grafting last year, this gives you a defined target for your result. Bring photos and clearly discuss your objectives. Best wishes.
From the images that you have posted, you still have pretty youthful cheek volume for a 57 year old lady, thus you likely have a significant amount of your fat graft still present. This doesn't mean that additional filler can't be added, in fact, that is the solution if you would like to have more volume in the cheeks than you have now. Only you can decide how full you would like your cheeks to be. In general I can tell you that most of my patients start with 2 - 3 syringes between the two cheeks, and we go up from there as needed. I would start conservatively at first, as you can always add more in a couple of weeks if needed. If you look at the patient information brochures distributed by Allergan or the Voluma website, you can see that the results that they are showing require anywhere from 3 to 7 syringes to achieve. I don't usually inject that much Voluma into a single patient, but it gives us a frame of reference for how much filler is sometimes needed to achieve a certain result. Hope that helps, good luck!
Dear Missy, thank
you for your question. Injectable fillers can be used to enhance facial volume,
correct lines and depressions, and rejuvenate the face without surgery. Some
common fillers include restylane, juvederm, perlane, voluma, radiesse,
and sculptra. Consult with a an experienced facial plastic surgeon
injector to review your options. Good Luck!
It is always difficult to tell from pictures how much filler would be ideal. With Voluma and good placement you can see lifting immediately even with just one syringe. I think your cheeks look great as they are and might suggest just one syringe split between the two cheeks. You certainly look younger than 57!