What can be done to smooth the lid cheek junction and reduce malar creases? (Photos)

Question

Hello. I received almost a full syringe of Versa filler in my tear trough area (.2ml left) a week ago. At the same time, I also received one syringe of Voluma to cheek bone area, higher up, not apples of cheeks. Now I have these big malar creases that make the under eye area look even more hollow. Are the malar creases I'm seeing just residual swelling or do I need more Voluma in the mid-cheek area or apple of cheek? Or do I need more filler under eyes, in tear trough area? Thank you.

S. Larry Schlesinger, MD, FACS · Answer

Voluma is hydrophylic and therefore the swelling lasts longer than some of the other HAs.  I would allow at least 7-14 days more before making a decision as to what needs to be done.  Obviously, an in person exam 2 weeks from now would be the gold standard for deciding what adjustments would be appropriate.That being said, if you were my patient, I would do more filling of your malar bone area to give some lateral dimension to your vertically oblong face.  Also, I would inject Vollure above any creases created by Voluma.  It will smooth the surface, is not hydrophilic, and therefore you get an immediate picture of how much is necessary to correct any visible unwanted creases.  I find direct filling in the infra orbital region can lead to abnormal bumpiness whereas mid-cheek pushing of tissue upward from low placement of Voluma can often elevate the perceived bottom of the lower eyelid, softening one's appearance.All that being said, I believe it is appropriate for you to go in and find out how your personal injector plans to deal with your concerns.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Based on the timing of your treatment I would advocate waiting at least another week before assessing your results for any revisions. Because of the thin nature of the undereye tissues they can hold on to swelling for quite a while, and I would like to see this resolve before pursuing any further treatment. Hope this helps.

Dilip D. Madnani, MD, FACS · Answer

HI, thanks for the pictures. It looks like you need a tweak of whats been done- more filler may be an option, however, I am not sure whats going on with your tear trough area. An examination would be ideal to determine what to do. If you could also post before pictures, that would help get a better sense of what was done and what to do.

Katrinka L. Heher, MD · Answer

I agree that you should wait for all of this to settle.  The key is to balance the volume to the tear trough with the volume to the cheek to achieve a smooth contour. Once the swelling resolves I believe you will be able to create this nice transition. It’s essential that the tear trough is slightly “under corrected” while the cheek is slightly “over corrected”.  Don’t give up! And best of luck.

Michele S. Green, MD · Answer

I would definitely wait at least one more week to fulfill the effect of your injections.  Right now you appear so swollen and I would advise against you having injections until you can understand what the true effect of your injections are.  Please consult an expert in facial cosmetic injections.  Best, Dr. Green

What can be done to smooth the lid cheek junction and reduce malar creases? (Photos)

Answers (5)

Answer: More filler?

Answer: More filler?

Answer: Malar Creases and Injections

Answer: Malar Creases and Injections

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Everything you need to know about Voluma

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

What can be done to smooth the lid cheek junction and reduce malar creases? (Photos)

Answers (5)

Answer: More filler?

Answer: More filler?

Answer: Malar Creases and Injections

Answer: Malar Creases and Injections

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Recommended reading

Everything you need to know about Voluma

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