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A rounded contour to the area over the cheek bones with an outward flare of the cheeks toward the temples that trails off like the tail of a comet along with a fullness below the eyes in the region closest to the nose are essential elements of the youthful and sensuous central face. Dents, creases, hollows and loss of convexity anywhere in this area signal aging. Cheek implants are of course one possible surgical solution. The use of fillers and volumizing agents, a totally non-surgical approach, is another. The latter, my personal treatment preference, allows for continuous "sculpting" and shaping of this region over time as loss in volume and gravitational changes continue their inexorable course. While hardier hyaluronic acid products, such as Perlane and Juvederm UltraPlus, have been used successfully for cheek augmentation, I prefer Radiesse for this facial unit. Composed of calcium hydroxylapatite, a moldable, viscous, bone-like material, Radiesse can be easily contoured and draped over the underlying cheek bones and provides sufficient volume and lift to sunken areas nearby. Additionally, it has been approved by the FDA to be mixed with a small amount of local anesthetic, which makes the twenty to thirty minute procedure relatively painless. Since it is a semipermanent volumizer, results can be expected to last between 1.5 and 2 years before a touch up is needed. The results of non-surgical cheek augmentation typically prompt a "Wow!" response from patients when handed a hand mirror right after treatment. Mild bruising, swelling, tenderness may follow and last for a few days, but most people return to their daily routines immediatley following treatment or the following day.
On a temporary basis, fillers can be used. The safest are hyaluronic acid based such as Juvederm or Restylane.On a more permanent basis, fat injection or autologous grafts may work well. In our practice we use LiveFill (TM) extensively, non-traumatized fascia fat grafts (no dermis).If volume has slipped south and the skin has become lax, a volume adjusting multivector facelift may give the best long term result.In any event, you may want to partner with a surgeon who can consider the face as an artistic whole, over time, to get your best result given your needs.
Dear Sus, as you can see there are many options. Things to consider are the longevity of the solution, possible downsides, recovery, cost , and other adjunctive procedures- whether they are surgical or non surgical. The key with any of the procedures is that the result looks 'natural' and does not have long term risk.With Warm Regards,Trevor M Born MD
This question has been well addressed and any filler (commercially available or autologous grafts) can essentially be used.:RadiesseJuvederm Ultra or Ultra PlusRestylane or PerlaneSculptraAutologous fat injections or dermal-fat graftsImplants (silicone, polyethylene, PTFE, polypropylene, hydroxyapatite, etc)Depending on the volume required, some may be prohibitively expensive for the volumes required and for maintenance.Also take into account your personal health and fluctuations in weight which may have an effect on the long term results.
it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin. In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result. In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.
