James M. Economides, MD, FACS

I understand your concerns about the various options for achieving fuller, rounder "baby cheeks," especially given the conflicting advice and risks associated with different treatments. Here's a breakdown of the available options and alternatives that might help you achieve the look you want, focusing on safe and effective solutions for your goals. 1. Cheek Fillers (Hyaluronic Acid-Based): Voluma or Restylane Lyft: While Voluma is commonly used for cheek augmentation, it is true that some practitioners avoid placing it directly in the buccal area because it can create an unnatural or overfilled look in this region. However, fillers like Voluma or Restylane Lyft can still be used in the midface or cheekbones to create a more rounded appearance if done conservatively. Pros: Reversible with hyaluronidase, immediate results, customizable for a natural look. Cons: Temporary, with results lasting 12-18 months, and should be done by an expert injector to avoid the "puffy" or unnatural appearance. 2. Fat Transfer: Fat Grafting: While you're understandably hesitant about fat transfer due to weight fluctuations, fat grafting can still be an option. When done by an experienced surgeon, fat can be precisely injected into the buccal and cheek areas to achieve the fuller, rounder look you want. Pros: Long-lasting (potentially permanent) results, natural-looking fullness. Cons: Some of the fat may not survive the transfer, and there's a small risk of asymmetry. Weight changes can affect the fat graft over time, but results can be stable with weight maintenance. 3. Combination Approach: Cheek Filler with Buccal Fat Preservation: Instead of focusing on the buccal area directly, a skilled injector could use fillers in the malar region (the upper part of the cheek) to lift and enhance the natural cheek contour. This combined with minimal filler in the lower cheek could give the full, round appearance without overfilling. Pros: More control over the outcome and ability to blend volume throughout the face. Cons: Requires a highly skilled injector to balance the look. 4. Sculptra: Collagen Stimulator: While you mentioned fat transfer as a concern, another option is Sculptra, which works by stimulating collagen production in the injected areas. It’s not an immediate filler, but it gradually builds volume and can give a more natural, long-lasting result. Pros: Gradual and natural volume increase, long-lasting (up to 2 years or more). Cons: Takes multiple sessions to see results, and it’s not reversible like hyaluronic acid fillers.

Yes, filler injections in the hollow of the cheeks can potentially cause bruising, but there are ways to minimize the risk. Bruising occurs when the needle or cannula used during the injection hits small blood vessels beneath the skin. Several factors, including the injection technique, play a role in whether bruising happens. 1. Administration Technique: Cannula vs. Needle: Using a cannula instead of a needle can reduce the risk of bruising. Cannulas are blunt-tipped and less likely to puncture blood vessels compared to needles, making them a popular choice for areas prone to bruising, such as the cheeks. Experienced Injector: A skilled injector familiar with facial anatomy will be more likely to avoid blood vessels during the injection, minimizing the chance of bruising. The injector's technique, such as injecting slowly and avoiding over-manipulation of the tissue, can also help reduce trauma to the area. Layer of Injection: Injecting the filler deeper into the tissue, where there are fewer superficial blood vessels, can also lower the risk of bruising. 2. Ways to Avoid Bruising: Avoid Blood Thinners: Stop taking aspirin, ibuprofen, and other blood-thinning medications or supplements (like fish oil or vitamin E) for about a week before the procedure, unless medically necessary. Avoid Alcohol: Refrain from drinking alcohol for at least 24-48 hours before your injection, as it can thin the blood and increase the likelihood of bruising. Cold Compresses: Applying a cold compress to the area before and after the injection can constrict blood vessels and help prevent bruising. Arnica or Bromelain: Some people use Arnica gel or Bromelain supplements before and after the procedure to reduce bruising and swelling. Post-Treatment Care: After the procedure, avoid strenuous activity, excessive heat (like saunas), and massaging the area for the first 24-48 hours to minimize trauma. 3. Expectations: Even with all precautions, some people may still bruise due to their skin’s sensitivity or underlying vascularity. However, working with an experienced injector who uses appropriate techniques (like a cannula) and following pre- and post-care instructions can significantly reduce the chances.

It's understandable that you're looking for more effective solutions to restore the lost volume in your lower cheeks. While Sculptra is a popular option for collagen stimulation, results can take several months to become noticeable and may not provide the immediate fullness you’re seeking. Here are some alternative options that may give you more noticeable and faster results: 1. Dermal Fillers (Hyaluronic Acid-Based) Juvederm Voluma, Restylane Lyft: These hyaluronic acid (HA) fillers provide immediate volume and are specifically designed to restore fullness in the cheeks. HA fillers are ideal if you're looking for a quicker, more noticeable improvement compared to Sculptra. Benefits: Immediate results, can be customized for the level of volume you need, and can be dissolved if you're unhappy with the results. Duration: HA fillers generally last between 12-18 months. 2. Fat Transfer (Fat Grafting) How It Works: Fat is harvested from another part of your body (such as your abdomen or thighs) and injected into the face to restore lost volume. Benefits: Since it's your own fat, the results are natural-looking and longer-lasting. This procedure can permanently restore volume if the fat takes well. Considerations: The recovery is slightly longer compared to fillers, but the results can be very effective for individuals seeking natural, long-term volume restoration. 3. Radiesse (Calcium Hydroxylapatite) How It Works: Radiesse is a dermal filler that not only adds volume but also stimulates collagen production over time. It’s thicker than HA fillers and can provide structural support to the lower face and cheeks. Benefits: It offers more immediate volume with longer-lasting results (up to 18 months) compared to HA fillers. Considerations: Radiesse is not reversible, so it's important to be confident in the treatment plan.

Based on your goals to reduce laugh lines, slim your mid and lower face, sharpen your jawline, and reduce the underchin bulge, there are a variety of both non-surgical and surgical procedures that could help you achieve the look you want. Here’s an overview of some effective options: 1. Laugh Line (Nasolabial Fold) Reduction: Dermal Fillers: Fillers, like hyaluronic acid (e.g., Restylane, Juvederm), are commonly used to soften laugh lines by filling in the creases. A small amount of filler can provide natural-looking results. Skin Tightening Treatments: Non-invasive treatments like radiofrequency (RF) microneedling or laser resurfacing can tighten the skin and reduce the appearance of laugh lines by stimulating collagen production. 2. Cheek Bulging and Slimming the Mid and Lower Face: Buccal Fat Removal: If you feel that the fullness in your cheeks is due to excess fat, buccal fat pad removal can help slim the midface and create a more defined contour. This procedure involves removing the fat pads in the cheeks to reduce fullness. Botox for Masseter Muscles: If your jaw appears wide due to overactive masseter muscles (the chewing muscles), Botox injections can slim the lower face and jawline, resulting in a more tapered look. This can also help with reducing the prominence of the cheeks near the lip corners. Chin and Jawline Contouring Fillers: Dermal fillers can be used to sharpen the jawline and chin, giving a more sculpted appearance. Hyaluronic acid fillers, like Juvederm Volux, are commonly used for jawline definition. 3. Underchin Bulge Reduction: Kybella: This injectable treatment is specifically designed to reduce submental fat (under the chin) by dissolving the fat cells. Multiple treatments may be needed for optimal results. Liposuction: If you have more significant underchin fullness, submental liposuction may be a better option for targeted fat removal. This is a minimally invasive procedure that can provide more dramatic and permanent results. Ultherapy or RF Skin Tightening: These non-invasive treatments use ultrasound or radiofrequency energy to tighten the skin under the chin, which can also help reduce the appearance of fullness. 4. General Slimming and Contouring: Non-Surgical Face Slimming: Treatments like Ultherapy (ultrasound-based skin tightening) or Thermage (radiofrequency skin tightening) can help lift and firm the skin, providing a more contoured look to the mid and lower face. Fat Transfer: If you want more long-term results, fat transfer can also be used to sculpt the jawline and reduce fat in unwanted areas. This technique harvests fat from one part of your body and uses it to sculpt areas like the chin and jawline. Final Recommendations: Consult with a Plastic Surgeon or Dermatologist: Since each person’s facial structure is unique, it’s important to have a consultation to discuss the best options for your specific facial anatomy. A combination approach may work best for you, such as addressing both volume reduction and contouring. Non-Surgical vs. Surgical: If you’re looking for less invasive options, start with treatments like Botox, fillers, and non-invasive skin tightening. For more dramatic results, procedures like buccal fat removal or submental liposuction can provide longer-lasting changes. By combining the right procedures, you can achieve a slimmer, more contoured face with a sharper jawline while reducing the appearance of laugh lines.

To detect the exact location of residual hyaluronic acid (HA) filler, an MRI can be helpful. The type of MRI you would need depends on the filler material, but for hyaluronic acid fillers specifically, here's what to consider: 1. Type of MRI: High-Resolution MRI: This is typically recommended for soft tissue evaluation. A 3 Tesla (3T) MRI machine offers a higher resolution and more detailed images, which can help differentiate between filler, fat, and natural tissue. Fat-Suppressed MRI: Since HA fillers are often used in soft tissues that contain fat, requesting a fat-suppressed MRI can help better visualize the filler by reducing the signal from the surrounding fat. Non-Contrast MRI: For most HA fillers, a non-contrast MRI is typically sufficient to visualize the material, so you likely don’t need contrast unless recommended by your radiologist or provider. 2. Specific Area to Scan: Be specific about the areas where you believe the filler remains (e.g., cheeks, lips, under-eye area), so the MRI can focus on those regions. This can provide more detailed imaging for the areas of concern. 3. Consult with a Radiologist or Plastic Surgeon: It's always a good idea to consult with a radiologist or plastic surgeon beforehand to ensure you're ordering the appropriate type of MRI for detecting filler. They can provide more specific guidance based on your case and areas of concern. Once the MRI identifies where the filler remains, you can proceed with a targeted plan for dissolving the remaining product.