Terence Tan, MBBS, MRCS(Ed)

Hi shellyb114,

Your concerns are fairly common amongst the patients that I see. While Botox or neuromodulator treatments reduce the wrinkles near the outer corner of the eye or crow’s feet wrinkles by relaxing the muscle, the wrinkles on your cheeks are predominantly caused by the folding of loose cheek skin when smiling.

As such, it would be preferable to consider skin tightening procedures. A good choice would be Ultherapy, which tightens skin by using micro-focused ultrasound energy to stimulate collagen production. The collagen produced naturally lifts and tightens skin. Other skin tightening treatments like Exilis 360 and Rejuran are also popular locally.

Dermal filler of the cheeks would also be useful for people with volume loss. Ageing reduces soft tissue and bony support over the tear trough, cheeks, and over the smile or nasolabial lines. Dermal fillers re-volumise the cheeks, restoring the natural contours of the face and hence reduce the wrinkles over the cheeks which appear during your smile.

Examples of dermal fillers include hyaluronic acid fillers, which are most commonly used. Collagen-stimulating fillers like Sculptra and Radiesse are also suitable and recommended for the cheeks. The choice between the different type of filler types depends mainly on patient preference as they all work well for this area. Patients prefer a longer-lasting filler and do not mind the need for repeated treatments initially, or patients who prefer the concept of using one’s own collagen for rejuvenation, would benefit from Sculptra and other collagen-stimulating fillers. People who prefer a convenient and quick rejuvenation should choose hyaluronic acid filler. They are available in different brands. Examples include Juvederm, Restylane and Belotero.

Of course, what I have highlighted is not exhaustive. You may want to approach your aesthetic doctor for advice on the type of treatment most suitable for you based on the results you wish to achieve!

Hi msjk908,

While both are suitable, Filler treatment is preferable if we were to choose only one treatment.

In general, people with slim facial profiles and prominent cheekbones would benefit from re-volumisation.

Cheek filler treatment lifts the jowls from above and helps smoothen your side profile for a youthful look.

People with retracted chins should also consider a chin filler and filler over the marionette lines to smoothen the jawline for more definition.

Hi Rihannon135,

Based on your photos, both Ultherapy and fillers would be suitable and since both treatments target different aspects of sagginess, doing both results in more natural rejuvenation. Let me explain.

Ultherapy tightens skin by using micro-focused ultrasound energy to stimulate collagen production. The collagen produced naturally lifts and tighten your skin. In my opinion, Ultherapy is especially useful for sagginess due to the weight of bulky cheeks.

Dermal fillers on the other hand replace lost facial volume. Ageing reduces soft tissue and bony support over the tear trough, cheeks, and over the smile or nasolabial lines. Based on the pictures, I would suggest getting some undereye fillers to reduce the hollowness under your eyes and reduce the appearance of your dark eye circles. Fillers can also be injected along your nasolabial and marionette lines to improve facial contour, which makes us look more youthful. Of course, if you are concerned about a weak chin, chin fillers would also be recommended.

There is no evidence that acne scar treatments would break down the filler but if that is a concern, you can always do filler treatment after you have treated your acne scars.

Hair looks good by the way. Hope that helps!

Hi Giving663755,

Please do not be embarrassed, medical professionals are here to help, not judge. There are several effective, FDA approved treatments for non-invasive fat reduction and CoolSculpting is a very popular treatment.

Research has shown that the fat reduction varies between 20-25% after a single session of CoolSculpting in study subjects.

As CoolSculpting is effective for most people, and the main determining factor for most people would be its cost-effectiveness. People with more troublesome fat will need more treatments for a good result and of course expectations also differ between people.

With a BMI of 29, some weight reduction would certainly help reduce your risk of chronic illness going forward and should be considered. Many people do not know that there are several effective FDA approved medical treatments that can be paired with a healthy lifestyle and CoolSculpting for synergy. Examples of weight loss medications include Saxenda, which works by making you feel less hungry, while Xenical prevents fat from being digested and hence absorbed by your body.

CoolSculpting, together with an effective weight management programme, will allow you to see better results, and to achieve your ideal body weight and body goals.

Hello! 

In the past, the Q-Switched lasers were commonly used for treatment of pigmentation and dark spots that have developed due to sun damage.

The Q-Switched laser uses selective photothermolysis, delivering energy to skin pigments to break it down. The body then clears the shattered pigmentation rapidly after treatment. However, heat production to the surrounding skin tissue during laser treatment can potentially damage the skin, leading to side effects and downtime.

Laser technology has improved over recent years. Newer lasers like PicoSure can lighten pigmentation through higher, faster energy pulses with minimal chance of side effects and with minimal or zero downtime.

The PicoSure laser is widely considered as the gold standard for treatment of facial pigmentation like sun spots, acne scars, and removal of tattoos. As Picosure is a picosecond laser, it delivers strong pulses of energy to the skin in picoseconds (trillionths of a second) compared to Q-Switched lasers which deliver the energy pulses in nanoseconds (billionth of a second). This means that PicoSure delivers intense energy to the skin to reduce pigmentation effectively. This intense energy is delivered in a shorter period of time leading to less heat production, resulting in a safer treatment.

If there is a choice between the two, I would recommend the PicoSure laser over the Q-Switched laser as the preferred treatment modality for skin pigmentation. Nonetheless, the choice remains yours and you should consult a doctor who can determine which laser is most appropriate for your skin. Hope the above helps!

Cheers, 

Dr. Terence Tan, Halley Medical Aesthetics