Should I go for cheek implants or fillers?
The appearance of cheek bone definition is a highly desirable characteristic of people who work as models and actors. Many people want better defined cheeks, whether their appearance is caused by genetics or related to bone and soft tissue loss with facial aging.
I’ll discuss how I help my patients every day make the choice between options such as cheek implants, fat grafting and injectable fillers.
Over the course of my career, I’ve been performing facial cosmetic procedures such as the full range of facelift surgeries, cosmetic and reconstructive upper and lower eyelid surgery, fat grafting for facial volume correction, and facial implant surgery, such cheek implants, chin implants, and tear trough implants.
I have continued to evolve my approach to helping my patients with cheek volume enhancement, focusing on some key aspects which are universally of high value to everyone I see in consultation. These are:
- rapid recovery
This understanding led to applying knowledge and experience in facial anatomy and facial cosmetic surgery with new techniques such as The Y Lift and applying newer, longer lasting hyaluronic acid fillers at deeper levels, such as the space between the bones and muscles.
This is also referred to as Structural Volumizing. This shift in paradigm has made a significant impact on how I counsel my patients.
There has always been an appeal to long lasting procedures, such as placement of facial implants.
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Cheek implant surgery involves placing these silicone implants from the inside of the mouth, over different aspects of the cheekbone.
Patients need about a week to recover from the surgery, which I perform using local anesthesia with LITE IV sedation.
Swelling can at times be more significant and take several months to resolve.
There are certain issues which come up after patients undergo cheek implant surgery.
Sometimes, the appearance is not quite what the patient was hoping to have. This can mean having to take the implants out which means another surgical procedure.
If the desired appearance can be created after implant surgery with additional placement of filler, then the patient may feel regret about the decision to have a “permanent solution” and still need to have filler placement.
Many people focus on having maximal symmetry.
Although facial implants can be customized to try to achieve this, it’s difficult to be certain of achieving maximal potential symmetry until full healing has been achieved.
An important variable which most people don’t appreciate until it’s explained is that facial volume continues to change with age. This means that bone loss, fat loss and thinning of the skin will impact the long term results of facial implants.
While I do perform cheek implants, often at the same time as another surgical procedure like facelift, I inform patients prior to the procedure of this ongoing loss of volume so they understand the limitations of facial implants and the possible need for additional filler later on.
Fat grafting for cheek volume in my opinion is not ideal to achieve the look of defined cheekbones.
Fat grafting is limited by unpredictability where 30% to 70% of fat placed will disappear.
Prolonged swelling with a high likelihood of asymmetry are problems I would advocate my patients to avoid for a more predictable procedure with minimal recovery.
My preferred volume correction procedure for the face is the use of long lasting hyaluronic fillers like Juvederm Ultra Plus, and Juvederm Voluma.
While these fillers are commonly available to aesthetic doctors, experience and technique matters more than the material used.
This brings us to the subject of injectable fillers.
During consultation, patients often express concern about fillers in the cheeks, potentially looking too round and doughy as seen in well known people in the media.
They also express concern about the longevity of the injectable fillers.
I explain to my patients that most practitioners including the so called celebrity doctors place injectable fillers just below the skin surface.
This space has limited capacity to maintain the structured appearance people want.
The placement may look good when the procedure is done but the filler can’t maintain the shape as the face moves, resulting in spreading or bunching in a way that is not ideal.
The technique I employ is called Structural Volumizing.
This method is derived from applying the same principle of surgical facial implant placement where the space being enhanced is between the bone and the overlying muscle.
Instead of placing a silicone implant in the operating room during surgery, I place thicker, long lasting hyaluronic acid filler in my exam room in a few minutes.
This placement between the bone and the muscle helps retain the consistent shape of the bone structure rather than an amorphous shape that can occur when filler is moving around in the more superficial soft tissue space.
The end result is more youthful facial definition.
The procedure is performed with blunt cannulas with minimal trauma so patients can appreciate their improvement immediately.
A significant benefit is in my ability to control the placement of small quantities of filler at different places to maximize balance and symmetry.
Neither facial implants or fat grafting can come close to this level of customization.
It should be noted that using this Structural Volumizing technique does require more filler material than is used in traditional superficial soft tissue placement.
By using longer lasting fillers such as Juvederm Ultra Plus or Juvederm Voluma, the results can last over 1 year and up to 2 years.
Procedures based on Structural Volumizing is not just limited to the cheeks.
Wherever I would have previously considered placement of a surgical implant, I can employ structural volumizing.
This includes the chin, jaw angle, jawline and tear trough.
This global approach to facial volume correction has actually become an alternative to surgical facelift in some patients as well as a strategy to improve appearance after facelift.
The convenience of performing Structural Volumizing as an alternative to surgery has encouraged so many more people to have this procedure since, it’s performed in a few minutes in an exam room and patients walk out looking and feeling more confident.
Patients typically go back to their usual activities such as work the same day or the next day.
This has been a great advantage for people who’ve come in wanting to look good for an event happening soon, such as a wedding, birthday or reunion.
Meeting the needs for patients who are busy and want safe, predictable procedures with minimal risk and downtime has been the inspiration which has driven my innovations throughout my career.
From performing cosmetic eyelid surgery and facelift surgery under local anesthesia with LITE sedation, bringing into focus the needs of different ethnic groups which require specific approaches to cosmetic eyelid surgery and the development of a system for nonsurgical treatment for male and female pattern hair loss, I can state that the application of long lasting fillers using the principles of surgical implant placement is another significant step in meeting the needs of a wide range of people in the modern world.
By Dr Amiya Prasad., a Board Certified Cosmetic Surgeon.