I have pillow face after cheek injections, if I remove them will my face sag? (Photo)

Question

I have been over injected in my face with fillers so I look like a pillow and the filler has been weighing down my cheeks. If I remove the filler will my tissue still hang or will the skin grow back and attach to my face? I am 30 years old.

Shlomit Halachmi, MD, PhD · Answer

When did you have the fillers injected?  How much was injected, and in which area?  If this was done recently, there may be swelling, which will subside.  In that case, be patient.  If the injections were more that a couple of weeks ago, you may be best off waiting for the filler to be absorbed naturally,  You can have the filler dissolved if it was hyaluronic acid, but if a large volume of filler was used, this may take multiple sessions.  If the filler was Sculptra or Radiesse, you will need to wait it out... 
For what it's worth, the photo shows a very youthful, natural face with apple cheeks.  If this is very different than the contours you had before, then only you can judge whether you like the current look...

Amiya Prasad, MD · Answer

Thank you for your question. You are 30-years-old, and had cheek filler injection, which you say was overdone. You are asking if the filler will make your skin sag if it is removed.
I can certainly help guide you with this question, even without a photo for reference, and without the benefit of a physical exam. As a facial cosmetic surgeon practicing in Manhattan and Long Island for over 20 years, I perform all types of facial rejuvenation procedures in my practice, from full facelifts, to non-surgical procedures including laser and radiofrequency procedures, and own several lasers including fractional CO2, as well as volume augmentation procedures using implants, filler, and fat transfer.
To answer your question, filler should not stretch your skin or cause it to sag. Hyaluronic acid and other cosmetic fillers are like a gel, so when they are applied, they tend to spread as they fill space instead of stretching the area. Even when a lot of filler is applied, they aren’t going to stretch the skin. This is especially true for someone younger like yourself because the skin is still very resilient, and still has elasticity. So, if you had hyaluronic acid filler applied to your face, like from the Juvederm or Restylane families of filler, they won’t stretch your skin if you have the filler dissolved.
Although I haven’t seen your pictures before treatment, 30 is still a bit young for facial filler treatment, especially at the cheeks. In your 30s natural facial volume from bone, muscle, fat, and soft tissue should still be quite ample for a youthful look. Facial volume loss due to aging does happen before skin and soft tissue sags, but usually I start treating patients with facial filler usually after 40, and in some patients in their late 30s.
To prevent a pillowy look, I place facial filler a little differently than most doctors. Facial filler placement is usually done at the soft tissue level, right below the skin. When placed in soft tissue, filler can migrate, which often results in looking soft or pillowy. To avoid this, I place filler at the deeper, foundational level of bone, and in between the muscle layer with a method called Structural Volumizing. With this technique, filler doesn’t migrate, and looks more natural, without causing the skin to sag because the skin is not supporting the filler, but the bone and muscle are. I use longer lasting filler like Juvederm Ultra Plus and Juvederm Voluma for areas like the chin, jawline, cheeks, and around the mouth.
I think that you can have filler dissolved at any time, without worry of having your cheeks sagging after treatment. I also suggest you observe your appearance without filler, and see if you like the look, and if your friends and family respond to the look. You are a bit young for filler, but other treatments to improve skin quality like platelet-rich plasma (PRP) lasers, and other non-surgical treatments can help you look your best. I hope you found this information helpful. Thank you for your question.

Shaun Patel, MD · Answer

It's important to know which filler was used and how much of it was injected prior. You are young based on the photos and so I suspect your skin still has enough elasticity that it should return to normal once the filler is removed.

Amy Miller, MD · Answer

You are beautiful!  Looking at your photo I would leave everything alone and let the fillers absorb slowly.  However, if you really hate it, get it dissolved with hyaluronidase (assuming it is a hyaluronic acid filler).  Remove it in stages, not all at once.  That way the skin has time to tighten up and return to normal, there will be less swelling and you may not need to remove it all.  Once the filler is gone you will go back to your pre-injection state, you should not be any worse off.  
Hope this is helpful,
Dr. Amy

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