How can I make sure to avoid the chipmunk cheek, fat cheek, round apple look with filler to the cheekbone? (Photo)

Question

I've noticed in many after pictures of patients and celebs that doctors try to create an ogee curve that looks very unnatural and too full. It is unnatural because it defies natural cheekbone placement. A good example of this is what happened to Megan Fox. In videos of her talking, you can see that she is overfilled at the apple and the entire cheek is way too big and doesn't move. Is it possible to only inject at the upper and lateral zygomatic arch if I want a thin, sculpted look?

Amiya Prasad, MD · Answer

Thank you for your question. You’ve asked in your question, without submitting an image, about improving your cheekbone area without looking like a chipmunk, and you mentioned a celebrity you feel doesn’t look the way you would like.
I can certainly share with you my experience discussing this type of question which comes up in my practice every day. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Fillers are a very significant part of my practice, so we go through a lot. We help people with both enhancing their features already in a naturally good place, and a lot of people with facial aging who’ve lost a lot of volume to restore it. Your concerns are consistently the same as others, not with this particular celebrity, but with lots of celebrities. 
We’ve always looked up to celebrities to guide us to what is attractive, and sometimes a little imbalance can cause concern about what is ideal and possible. Very often patients say, “If celebrities are so rich and are able to get anything they want, why do a lot of them end up like this?” It really has more to do with the individual’s perception, and their doctor’s perception of what is attractive. 
To avoid looking like a chipmunk, it’s very important you work with a doctor whose perceptions and aesthetic style doesn’t result in patients looking like that, and you can tell by looking at their before and after pictures. Very often, you can tell by looking at the doctor’s staff. Very often, staff members will be very happy to share with you what they had done, so you can get a sense of the doctor’s aesthetic. When it comes to this chipmunk cheek look which is unfortunately very common and often seen in the streets of New York City, as well as in areas of Long Island where our offices are, I would say one of the things is the consequence of good intention. Volume loss happens with facial aging, and volume enhancement can also be done for a younger person. Often, you don’t realize and appreciate the dynamic nature such as when at rest,  the look may be fine, but when you smile, the volume can shift upwards and look  very chipmunk-like. 
I try to help people understand that  when we enhance cheekbones, we do something called structural volumizing. To distinguish this from what is generally done by more than 99% of doctors with injectable fillers placed typically in the skin level or just below it in the soft tissue, right under the fat cell layer. In shallower placement like this, the skin is mobile and moves around. In contrast, what we do with structural volumizing is place fillers at the structural level, at the bone level, between the bones and the muscles. By enhancing the cheekbone, the cheekbone is stable and the skin slides over normally, therefore, you are not pushing the added volume upward, creating a chipmunk look. It’s a very elegant, nicely done strategy. When people look at themselves when I’ve done this, they’re really excited and happy about how nice, natural, and at the same time how dramatic it can be. 
It’s really about the art of placement, location and having the right vision. I spend a lot of time with my patients to figure this out because the cheek is not just one spot - it starts in the center of your face, and goes back, so you have to be very clear. You and your doctor need to have a good understanding. What I’ll typically do is draw on the patient, and show where I’m going, and what I’m planning to do. It’s almost like a road map, then placement is done, and with that, my assistants also give me a feedback. When my assistants tell me it looks good, and they like the way it looks, it’s usually right on the mark. 
I think the structural volumizing concept is something that can help you avoid the chipmunk look. I think level of placement, and equally or more important are the vision and artistic sense of the doctor you’re going to, so meet with several doctors to learn about your options, and see what their style is. Get to know the doctor, and see if this concept resonates. If you like the results of their sample work, there’s a good chance you’ll like what you’ll have when you have this done. It’s very important to have a good relationship. When I think of myself and the way I take care of my patients, and being in practice over 20 years, I’m basically their primary care doctor for beauty. We have longstanding relationship where they’ll come in for one thing, then a few months or year later, they come in for something else. At least what we have is a good relationship where the patient and I are at the same frequency, which is very important because you can continuously address any issues as they come up, and explore things in a way that makes optimal sense so you look natural and a little better. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Morgan Rabach, MD · Answer

Hello,
Thank you for your question. I agree! Voluma is a great filler for cheek augmentation. To get the look you would like seek a board certified dermatologist or plastic surgeon who has experience with this filler. Voluma has an incredible natural lifting effect. Using a conservative amount of product will avoid the overfilled look that you do not like.
Hope this helps,
Dr. M

Jean M. Casello, MD · Answer

You should have a discussion with your practitioner before under going any procedure. You can discuss what your goals/fears are and the "look" you are trying to achieve.An injector should have not only expertise but also an aesthetic "eye" to give you results that are natural and acceptable to you.

Lesley A. Rabach, MD · Answer

Thank you for your question - a good and common question among patients seeking midface rejuvenation. The key is seeing a board certified dermatologist or board certified facial plastic surgeon who performs many of these procedures who has an aesthetic eye for creating the contour you are looking for without overdoing it! Best of luck and hope this helps.

Michele S. Green, MD · Answer

Yes, unfortunately there is now an overfill in the cheek area just as there had been in the lips.  You need to consult a board certified dermatologist who has a good aesthetic and understands what you are looking for. "Less is more" when it comes to fillers and you can always add more later.  Best, Dr. Green

How can I make sure to avoid the chipmunk cheek, fat cheek, round apple look with filler to the cheekbone? (Photo)

Answers (5)

Answer: Mid face injections

Answer: Mid face injections

Answer: Cheeks and Fillers

Answer: Cheeks and Fillers

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How can I make sure to avoid the chipmunk cheek, fat cheek, round apple look with filler to the cheekbone? (Photo)

Answers (5)

Answer: Mid face injections

Answer: Mid face injections

Answer: Cheeks and Fillers

Answer: Cheeks and Fillers

Browse related questions

Recommended reading

Everything you need to know about Dermal Fillers

Our mission is to create a world where every investment in modern beauty is Worth It.