Best Option for Cheek Dents?

I have developed these dents on my upper cheeks.They create this ugly shadow that looks as if my cheek is sagging. I used Juvaderm to fill in the dents but I was left with a bluish tint that made the whole thing look worse. Since then I have seen 3 different plastic surgeons that have all recommended different procedures. One said Fat transfer, another said Boltero used sparingly, and one said a Mid-zone face lift. I am left very confused as to what to do. Any advice is greatly appreciated.

Doctor Answers 3

Best treatment for a cheek dent

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Dents are typically more of a "volume loss" problem than a "wrinkle" problem. When treating problems due to volume loss such as cheek hollows and sagging skin, I will almost always use a deeper filler such as Radiesse. It is injected deeper, beneath the skin, and will generate more volume to create a much better lifting effect for sagging skin. Hyaluronic acid gels such as Juvederm and Belotero are injected more superficially in the skin rather than beneath it. They should not be used to create volume.

South Burlington Dermatologic Surgeon
4.4 out of 5 stars 13 reviews

The Nonsurgical 3D Vectoring Facelift Can Work For Facial Dents and Sagging

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Fortunately, over the last decade our understanding of how our skin ages has undergone a revolution. Age related dents and sagging result largely from volume loss. For these kinds of problems, we now have the Nonsurgical 3D Vectoring Lift.

A vector describes a magnitude and direction of force. Aging skin is characterized by a negative downward and inward vector of sagging. To counter this, surgeons traditionally pulled skin upward and outward--i.e. using a positive vector. The key difference between the outcomes of traditional surgical correction and nonsurgical 3D vectoring, both of which lift upwards and outwards, is the Nonsurgical 3D Vectoring Lift's additional corrective dimension of ‘forward projection’. This 3D effect is the result of volumizing with the use of injectable agents designed for this purpose, such as Radiesse, Voluma, Restylane SQ, and Stylage XXL.

The Nonsurgical 3D Vectoring Lift is predicated upon the fact that the face and portions of the neck differ in their degree of mobility. The region directly in front and behind the ears is a fixed, denser, relatively immobile area, in contrast to the mid-cheek region (hence the greater tendency of this region to sag with the passage of time). These anatomical differences are exploited in the Nonsurgical 3D Vectoring Lift by making the fixed areas serve as anchoring points for the mobile tissues.

In determining the positive vectors for the mid to lower face, the tissues that require lifting are identified by pulling the skin directly in front of the ears in a direction perpendicular to the area that requires correction. If the pulling results in lifting of the desired tissue, then the vector has been correctly identified and is then marked in accordance with 3D vectoring protocol. A similar approach is used in the region of the bone in back of the ear when dealing with neck laxity. One the proper vectors are marked, the volumizing agents are injected in a series of radiating bands that serve as support struts to the skin and that impart the necessary 3D outward projection--the lift--that distinguishes and defines this nonsurgical approach. The high viscosity and elasticity of the volumizing fillers serves to hold and re-support the overlying tissue and restore more youthful contours.

Although volumizing fillers are reabsorbed over time, they do promote new, native collagen synthesis, which may continue to provide structure, firmness and improved skin quality while continuing to lift tissues. A typical Nonsurgical 3D Vectoring Lift of the face takes about fifteen minutes to perform. Bruising and swelling tend to be minimal, and most people can return to work or social activities immediately following treatment.

Consultation with a board certified aesthetic physician with experience with this technique would be advisable.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Best Filler For Cheek Dents

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Radiesse is generally a good option for correcting volume loss in the cheeks. Facial fat transfer may be a good choice for you, however, since you did have an adverse reaction to Juvederm. With a fat transfer, you eliminate the risk of allergic reaction since the fat cells are taken from your own body. But Fat Transfer is a much more intensive treatment and results may not last. The reason for the blue tint is the placement of the Juvederm too close to the skin surface. This can be dissolved with hyaluronidase. Finally Belotero is also a good option. You can see that there are many ways to help your “problem.” It is best to find a dermatologist who is expert in all of these techniques so that the best treatment for you can be performed.

Mitchel P. Goldman, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 26 reviews

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.