Fillers or implants for angular cheeks? (Photo)

Question

Hi, what sort of augmentation should I pursue to best achieve mads mikkelsen’s cheekbones. When I think of cheek filler I see puffy round perhaps feminine faces and I prefer angular cheekbones with hollow lower cheeks seen as a plus.

Jed H. Horowitz, MD, FACS · Answer

Hello humeThis can be done either by using cheek implants or fillers, a consultation with a board certified plastic surgeon would help you make the right decision..

Jason Emer, MD · Answer

Volume and contouring of the cheeks can be created with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra. Implants or fat are alternatives. Botox and radiofrequency can help slim and contour the jawline. Liposuction can help slim the face. Ultherapy, J Plasma and rf treatments can provide skin tightening and lift. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you are a great candidate for malar enhancement.  This can be
done in one of two ways.  Voluma is an injectable filler which can be
injected into the malar region as a temporary filler.  Malar implants can
be placed as a permanent way to gain volume in the cheek.  I always use
medpor implants with screw fixation.  Silicone malar implants tend to
have a high rate of malrotation over time.   I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Michael I. Echavez, MD · Answer

Injectable fillers and implants can both produce augmentation of the cheeks.  Since fillers are relatively softer than solid implants, I would say that cheek implants could generally produce a more dramatic and angular appearance.  Cheek implants are also permanent, unless removed for some reason.

Barry L. Eppley, MD, DMD · Answer

Cheek implants because of a stronger bone push on the overlying soft tissue have a much better chance for making angular cheek definition than softer gel fillers. That type of cheek augmentation look, however, is going to require a special design cheek implant as no standard cheek implants are designed for that effect.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, silastic facial implants (cheek implants, chin implants or lip implants), liposuction and/or facelifts for over 30 years.  From the photos, your cheeks are very flat in the front.  
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using silastic cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face. Conversely, men look chiseled and handsome with angularity in the cheeks (like the male model photo provided), chin and mandibular angles.   Be certain to consult with a "facial shaping expert surgeon" who understand the difference between feminizing and masculinizing the face.  If you are truly interested in masculinizing the face, there are proper aesthetic solutions to accomplish that goal using either dermal fillers or silastic cheek implants.  Fat transfer (fat injections) using "any"method should be avoided however for the reasons discussed below. I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

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