Safe Filler for Submalar Triangle? Juvederm Voluma Not Recommended by Doctor?

Hi Angela,Voluma was recently FDA approved in the US for Cheek augmentation.  Although the main benefit of the Voluma is it's Lifting power, because it tends to stick to itself, it is particularly good for placing on top of the cheek bone similar to your malar augmentation AKA cheek implants.  The submalar area is where the natural "baby fat" in our cheeks get lost as we age.  The normal baby fat is called the buccal fat pad.  As we age we naturally lose it.  Some people who feel their cheeks are too chipmunky or too full, may request to have the buccal fat pad reduced or removed surgically.  I think this can prematurely age that person, and if it is overly full, it can help keep the person looking younger appearing than their chronologic age.  Since my specialty is trying to make people look younger (facial rejuvenation), I see the benefit of preserving the natural buccal fat pad, as well as augmenting the submalar area if it is deficient.Juvederm Voluma lasts longer than Juvederm and Restylane.  In the FDA studies, patientd did not need touch ups until after 2 years and even then, there was still about half of the Voluma results still present after 2 years.  This means the touch up injections should be less than the original amount.  Sculptra is injected directly under the skin and not in the buccal fat pad area, which is much deeper.  If you place your finger inside your upper lip under your cheekbone essentially the cheek between your finger and the skin is the tissues which need to be thickened.  Since you have cheek implants, we should at least discuss submalar implants.  These submalar implants are not implanted into the tissue between the inside of the lining of your mouth to the skin, instead it is place under the cheek bone.  I have removed submalar implants which essentially were sticking into the mouth above their upper teeth line.  Perhaps they moved, but I don't like to restored appearances in an non-anatomic way.  The same comment goes for fat grafting which is placed in different layers under the skin, but does not actually filler the buccal fat pad space.  I don't know what is done with silicone, but it is certainly off-label as a filler in general let alone large volumes such as the submalar area.  The best technique for silicone is called the microdroplet technique.  If multiple cc's of volume are injected, I suspect the microdroplet technique goes out the window, since there may be more filler, and less tissue to actually hold each microdroplet.  I have used Juvederm Voluma to augment the submalar area.  I use a microcannula from Dermasculpt.  In order to restore the buccal volume anatomically, I go deep and aim for a spot under the cheek bone, where it seems to open up anatomically.  The Voluma is not felt on the surface of the skin since the goal is to try to reinflate the buccal fat pad space which has deflated.I hope that makes sense.Best,Dr. YangP.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.

I read your concern. Hollowing below your cheek-bones in the "sub-malar" area is quite common. In my practice, I prefer to add volume to your cheeks with Silikon-1000, an off-label filler for permanent results.

Dr. Joseph

I always like the thicker longer lasting HA's like Perlane or Juvederm Ultra plus to add volume in this area.  They work really well.