In my practice, I have more or less completely switched to fat grafting if patients want augmentation to the cheeks.
We combine the Jet lipocollector fat harvest system with a defined addition of platelet rich plasma.It has taken us some time, but I think we have found the perfect mixture.
If one uses a multiplane injection technique, the result can be dramatic, and there is very little risks associated since we use the pateints own tissue.
The multiplane injection technique has got a certain learning curve, but once mastered, this solution is far superior to any commercial filler, regardless of what nature.
My patients also like this solution because in the medium/ long term it is more cost effective, since they don't need continous top ups.
I Was Told Radiesse Is Not For Me Yet, What Do You Suggest as an Alternative?
I prefer using Perlane for facial shaping and augmentation. Be sure the MD, you select, understands and follows the proper aesthetics of facial beauty for the creatioin of a naturally, more attractive face. There's no magic in any filler or procedure...the magic lies within the proper aesthetics applied to your particular face.
Personally, I like to use the large molecule size products like Perlane of Juvederm ultra plus for the cheeks. I reserve restylane for the lower lid tear trough region.
Juveder and Restylane work best for nasolabial folds while Radiesse and Sculptra are better for volume loss
Restylane and Juvederm are essentially the best for the nasolabial folds and more superficial lines. I believe they fill an area quickly and last for a good period of time with extremely low to no downtime (based on your personal experience with bruising which technically should be rare).
Radiesse and Sculptra last longer and are injected deeper in the tissues for an overall volumizing effect. In my opinion they are better for rejuvenating the cheeks and areas of the face that have lost fat with age or had the fat droop away like in the jowls, temple, and tear trough areas. There is usually some minimal down time involved due to the swelling of the fluid injected, but they typically will last longer and may provide a liquid 'face lift' effect.
Most filler are technique dependent so be aware of this.
Choosing the right filler
Choosing the right filler requires skill and experience. Because of your youthful age, your doctor probably thought that Radiesse might be too much (although you could always just try a small amount). Radiesse is a great volume filler for cheeks and deep nasolabial folds and it is used deep. Restylane/Juvederm are basically the same product and are great for more superficial lines/wrinkles or mild volume filling. With regard to bruising, Restylane and Juverderm are the same.
Radiesse in a younger patient
I prefer restylane or Juvederm in these areas because it is reversible and less likely to show through thinner skin when injected superficially. Deeper injections are okay, but I prefer Perlane again for its reversibility.
Best treatments for cheek folds
If your cheek folds are not too deep, Restylane is a great choice for your treatment. Bruising is the same for Restylane and Juvederm and is more "technique dependent". Since Restylane has a higher G’ and G’’ than Juvederm, it is a firmer, more viscous gel which can therefore create more lift and volume, making it a better choice for nasolabial folds.
Juvederm and Radiesse are comparable fillers made by different manufacturers. Restylane may be a better option for someone at your age with early creases. It does create bruising which should resolve within two weeks. Without a photo, it isn't possible to address the issue of whether you are a candidate for fillers now or if this is premature.
Which filler in the cheeks works best.
There is no one best filler for the cheeks. The ones you have mentioned will all get the job done. The experience of your doctor and the analysis of your volume needs are what seem to be driving her recommendations. What you have read about Restylane may be based on the fact that more robust fillers such as Perlane or Radiesse are more appropriate for the cheeks ( not that Restylane is "NOT good" ). One filler does not cause more bruising than another. Generally, bruising is very dependent on the individual patient 's tendency to bruise, medications that may contribute to it, as well as the technique of injection. I have incorporated the use of fine gauge, blunt tipped injection cannulas ino my injection practice and have been extremely pleased with how little bruising there is with this technique.