Radiesse Sagging - Would More Filler Like my Cheeks?

"Santa Jowls",

I agree partially with what others have said in response to your question.  I would like to put this spin on it.  I assume that you, like most people who have facial fillers are looking for subtle improvement without surgery.  Like everything, it's all about your expectations.  It is difficult to make comments based on one photo, but here is what I think.  Overall, your face appears to have lost volume.  You can seen in the picture more on the left side where the area below the cheek bone prominence looks flat.   On the right side from the front, this is seen as a shadow that runs from the corner of the eye at the nose down toward the back part of the jaw.

The trend with fillers is to, as you have pointed out, is to try to restore midface volume, which 1) tends to pull subtly above the nasolabial folds, and 2) draws attention away from the nasolabial folds.  Completely effacing the folds directly  leads to the look you describe.  Why? Because the fold is a natural anatomic region.  The fold becomes more prominent as you lose fat in the areas above the fold and the tissue sags. Filling the fold itself does not treat the cause of the problem in the first place.   Therefore, I do like to try to fill the areas just under the cheekbone prominence.  This can be done with any of the fillers commonly used, such as Restylane, Juvederm, Radiesse, etc., as well with the relatively new Sculptra Cosmetic.  Fat transfer is also something to think about.   Yes, there are surgical options, but your question about placement of filler in a different location is a valid one.   Hope this helps...

You might only be noticing the jowls more now because the smile creases arw better after the filler. You could benefit by more filler in the marionette lines but that won't address the jowls nor would more mid cheek augmentation. A facelift would help lift the jowls.

There might be some swelling but inspite of that you have a problem. The radiesse was injected in the wrong areas.

Id this persist then see a BOARD CERTIFIED PLASTIC SURGEON  TO DISCUSS YOUR OPTIONS.

Radiesse can not be disolved and in certain areas can persist for a long time

You problem may require surgery to comouflage the radiesse

How long has it been?  

I suggest waiting at least 2 weeks as some of what you may be seeing is swelling.  Radiesse is usally diluted with lidocaine and some patients swell up more than others.  The swelling then migrates south giving more jowels which improve as the swelling goes down.   We do love Radiesse in the cheeks and midface injected deeply for facial sculpting and I suggest that you speak with your Board Certified Plastic Surgeon doctor about trying this.

I don't have a preop to compare to.  I think that you might investigate a cheek or lower face lift- longer lasting, more cost effective, and will address more of your needs.  Just a thought.

Regarding: "Radiesse Sagging - Would More Filler Like my Cheeks?
The Radiesse I received was one syringe used along my nasal labia folds and at the point of my cheek bones that is nearest my nostrils. I hate the look. I now have droopy jowls, my cheeks are saggy,and my smile looks crowded, and the corners turn down due to the weight surrounding them. I naturally have voluptuous lips that now appear small and unnoticeable. The sallows of my cheeks is still prominent as I have "horsey face" now. Would it be best to add more filler to higher cheek bones?"

There is a widely held misconception out there that ALL facial aging can be EQUALLY reversed or corrected with Botox and Fillers (IE the "Liquid Facelift) by repeatedly pumping the face with generous amounts of fillers and Botox. This is a total fallacy perpetuated in part by non-surgeon who cannot offer some patients more effective surgical solutions.

Facial aging is NOT only the result of loss of bony and soft tissue facial volume. It that was the only cause, ALL facial aging could then be corrected by facial volume restoration (fat and other fillers). An equally, if not more important cause is facial tissue sagging.

Facial tissue sagging leads to:
- lengthening of the height of the lower lid and bulging of the lower lid fat
- uncovering the lower rim of the eye socket creaking the Tear Trough or Naso Jugal lines
- inferior drifting of the cheek with creation and deepening of the nose to lip (Nasolabial) lines, the down turning of the corners of the mouth and marionette (puppet or drool) lines and the jowls.

Fillers can ONLY push forward and smooth a line on top of them. They cannot mobilize and sift the whole cheek mass to where it was located in a woman's early 20's.

I apologize if I am lecturing you but you have to fall back on common life experiences and ask yourself HOW could 0.5cc, a minute amount, placed along the base of the nose and the upper Nasolabial possibly cause an avalanche of the cheek mass soft tissue that you think it did? It is a physical impossibility. I suspect that you had progressive aging changes that the failure of this treatment made more obvious to you.

As regards, "The sallows of my cheeks is still prominent as I have "horsey face" now. Would it be best to add more filler to higher cheek bones?", only an in depth consultation would allow one of us to tell you what, based on YOUR preferences, may be best for you. If I can guess, I would say that you may look a LOT younger and more attractive with a MACS Facelift than with continued filler injections.

A Facelift, depending on the technique, would correct the jowling by repositioning the cheek mass where it belongs and thereby restore the youthful oblong / upside down pear shape to your face.

Good Luck.

Dr. Peter Aldea