Cheek Augmentation - Which Technique is Superior? Intraoral Route?

I am considering getting a filler to the cheeks to get more volume. Due to my age and genes I have lost fat in my face which makes my face look a bit gaunt. I am considering getting a Hyloronic acid. Since I am a terrible "bruiser" (I got a permanent bruise a year ago from 1cc Restylane in the cheeks despite going to a top injector) I would like to get it the introoral route time. Is this technique more difficult and more dangerous in terms of risks of getting a nerve damage or hitting a vessel or nerve?

Doctor Answers 7

Cheek Fillers

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No, but I personally think it would be far more difficult to properly shape the cheek into a more aesthetic, attractive cheek using intra oral injections. I have been shaping Cheeks with Implants and fillers for over 20 years and use a surgical marking pen to place dots on the skin where the filler will be injected to create the desired cheek shape. This would be very difficult to do through the mouth in my opinion.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Cheek Augmentation

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Fillers for cheek augmentation can be delivered via the external or intraoral approach. There is no difference in possible complications. I prefer to use Radiesse rather than hyaluronic acid  because it arguably lasts longer.Consider cheek implants ,placed through an intraoral incision, which are permanent.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Cheek augmentation technique

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Cheek augmentation with dermal fillers can be done through the intraoral route or percutaneously, which is not any more difficult. A permanent solution to filling this area would be cheek implants, which are made of silicone plastic wafers. These are placed through the intraoral route just above the teeth, positioned on the bone and can give a very accurate and permanent, long-lasting augmentation of the cheeks. They can be placed in a slightly lower position if there is more buccal fat pad atrophy than an actual bony augmentation higher up. It is rare to ever have any numbness or nerve damage from this type of procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Hyaluronic acid injections- intraoral vs. transcutaneous

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Both methods are very straightforward for a surgeon with experience operating in this area. The intraoral route obviously involves a less sterile route, so theoretically the infection rate would be higher. The rate of significant bruising should be very low through the cheek skin.

If you had a lot of bruising, you may want to investigate why-- was there an undiagnoses bleeding problem, aspirim or nonsteroidal usage, etc?

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Cheek augmentation

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There is a risk of nerve damage with either technique but I do not know of any reports of one technique being higher than another. Make sure you avoid aspirin and other blood thinners which will increase chance of bruising. Ice before and after the injection may decrease your chance of bruising as well. The injectables can really help with the deflated look. Best wishes with your injection.

Sharon Theresa McLaughlin MD
Long Island City Plastic Surgeon

Cheek Filling

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People bleed longer because their blood takes much longer to clot. This is commonly caused by certain foods that we eat WHICH ARE GOOD FOR US (such as garlic, Ginger, Vit. E etc, etc) OR because of a genetic anomaly which slows clotting. IF you can get your doctor to give you the list of foods and medications (such as Aspirin, Advil, Nuprin etc) NOT to take, you will really decrease the odds of bruising. If you have a genetic cause, there is not much, short of taking certain expensive medications in some cases, to normalize your bleeding time.

EITHER WAY, if your blood is thin (genetically or because of what you ate), it really does not make a difference HOW the filler is placed. Whenever a vessel is punctured, pressure needs to be held until clotting occurs. But, in your case that would take a lot longer and bruising would occur.

As a general comment the cheek has 4 major arteries whose branches inter-communicate and the branches become smaller as they come close to the surface. Going through the surface would probably have less of a chance of hitting the larger branches.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Fillers placed through the skin or the mouth

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If it is bruising you are worried about, the route of injection doesn't matter because the long term bruises are not from skin blood vessels but from deeper blood vessels in the tissue that get in the way of the needle.

I personally don't do any intraoral injections because of the small but theoretical increased risk of infection injecting through the contaminated oral bacterial flora.

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.