Deep Wrinkle on Cheek That Doesnt Go Away with Fillers, What Other Options Do I Have? (photo)

twice I have gotten Juvederm injected to fill that line that you see on my cheek and to no improvement whatsover. Once with a dermatologist and the other time with a plastic surgeon. I am 23 yrs old so i dont know if its just genetic or aging, but I desperately need to get rid of it. Basically what happens is when the filler is being injected, for some reason the filler fills AROUND the line and not the line itself. My dermatologist thinks its scarred tissue that may need to be cut off. HELP!!!

Doctor Answers 3

Fillers may not be best for deep wrinkles on the cheek

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These depressions in the face can be difficult to treat and I find they are particularly annoying to patients who only have them on one side of the face, so it really stands out. Fillers often don’t work because the problem is a connection that has formed between the surface layer of the skin and the deeper tissues. This connection leaves no place for the filler to rest when it is injected.  It is forced to either side of the connection making the wrinkle look even deeper after the treatment. The best way to fix this problems is to use a special instrument to free this connection and then fill this space with your own fat.  This gives a long lasting, soft appeareance with near normal contour.


Restylane and Radiesse as Additional Filler Option For Wrinkle on Cheek

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In some situations, Juvederm does tend to migrate to other areas, as you have already experienced. Restylane is also made of hyaluronic acid, but it is more viscous and tends to stay at the injection site.One of the problem with this area is the tendency for edema to occur. The area above the line is more spacious and the skin is tagged less to deeper tissue. Also the skin is thinner. So there is a higher tendency for dermal fillers to migrate into the area and for edema to occur. 

In my experience, very superficial as well as deeper injections in combination has worked well. I find Radiesse to work well. When superficial injections are done with hyaluronic acid fillers, there is the risk for tyndall effect to occur resulting in a bluish hue that gives the appearance of a bruise. Radiesse does not have this tendency. It is made of a calcium compound suspended that can be used to correct structural issues on the face.  It creates a lattice beneath the skin upon which new collagen fibers develop. This enables it to provide more support for areas that require this. In the area of your problem it actually lifts up the malar mound instead of inflating it.

With this injection as well, the physician can shape it once it is under the skin and it is less likely that it will migrate away from its intended destination. However, all patients are different and one approach does not fit all, so discuss these issues with you dermatologist and plastic surgeon.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 33 reviews

Filler for lines

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Thank you for the picture, this is very helpful.  These lines can often be difficult to treat.  I have found that using Restylane in a more superficial pattern can often fill in the valley that is creating the line appearance.  Juvederm has slightly more fluidity then Restylane and may not fill the area as well.   Make sure you go to a a board certified physician who has experience with fillers in this area.

Monica Halem, MD
New York Dermatologic Surgeon

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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.