Cheek Injections for a More Youthful Looking Face

It was once thought that the secret to returning the face to its former youthful appearance involved simply lifting and re-draping sagging skin.  Then as surgical procedures evolved, lifting and redistribution of the muscle was incorporated.  Eventually it was realized that facial fat loss significantly impacted the appearance of the face as we aged.  When fat loss is the culprit we can refer to the effect as “pseudoptosis”.  Granted, the skin itself is affected by aging as well, especially when it has suffered from sun damage.  As we age elastin fibers break down and the skin’s elasticity is compromised. Coupled with thinning of the skin, the face takes on a “sagging” appearance.  As we mature, the facial fat loss compounds the issue.  Even when our skin is very healthy and plump, this volume loss can occur and still create that deflated appearance.  

Fat loss may become apparent as early as in the late 20′s and up, usually becoming very apparent in the mid to late thirties.  You might feel that you look gaunt, worn out, and your under eyes may have developed sunken circles underneath them.  Your cheeks may not be as high as they once were, and deep lines (called nasolabial folds) which run from your nose to your mouth may begin to form.  All of these together creates an older looking you.  All of which may be easily fixable.

Efforts to restore volume to the face has included facial implants, redistribution of the underlying muscle, and eventually the use fat and injectable fillers into the dermis and also into the muscle.  Recently, surgeons at UT Southwestern Medical Center have discovered 4 key fat pockets found deep under the skin that when injected with even small amounts of fillers (such as fat, hyaluronic acid, etc.) can significantly rejuvenate the appearance of the face.   I have had fat injections, Restylane, Sculptra and Juvederm in an effort to keep the effects of aging at bay. And it works! A little goes a long way and if you keep up the maintenance, your face will thank you for it.

In a study lead by Dr. Rod Rohrich, Chief of Plastic Surgery at UT Southwestern Medical Center study, researchers injected 14 cadavers with dye and latex to mark the boundaries of these deep fat pockets. The doctors concluded that these fat injections returned the lateral projection of the face and gave the face a naturally rejuvenated, fresh look without the negative effects of prior methods.

“**METHODS:: Fourteen hemifacial cadaver dissections were performed using the dye injection technique to identify deep medial cheek, submentalis, and sub-orbicularis oris fat compartments. Latex injection was used to investigate the arterial supply

So what about when too much of a good thing is simply too much? Even today some surgeons are still injecting a considerable amount of fat into the dermis to rejuvenate the face. Overstuffing patients with can make your face look bloated, and undefined.  The goal should be a softer appearance such as you were when you were younger, not a bloated, “fat-faced” version of yourself. This volume restoration to specific areas is what is going to get us there. Injecting fat into these deep fat compartments will reduce the amount of fat needed for your procedure and give us a naturally rejuvenated look, not a puffy, pulled -too-tight result.

I certainly welcome new research which can eventually make it to the operating table near me!  I hope that the method will become more mainstream and these new findings will be made available to us in the form of an advanced treatment.  I suspect I may need more fat grafting in the coming years and hope this method will be perfected by then. 

Sites & Sources:

**Plast Reconstr Surg. 2008 Jun ;121 (6):2107-2112 18520902 The Youthful Cheek and the Deep Medial Fat Compartmen. (R. Rohrich, J. Pessa, B. Ristow

Dept. of Plastic Surgery, University of Texas Southwestern Medical School; California Pacific Medical Center)

To Tell or Not to Tell?

Every time someone asks my opinion on if they should tell a spouse, employer, friend, or child about their decision to have plastic surgery, my answer is always the same.   This is a very personal decision that must be made on your own. For some, it is a decision made with much thought; for others it is simply a matter of when to tell.  The question you have to ask yourself is what type of person are you?

Questions You Should Ask Yourself:

1. Are you the type of person who is easily hurt by the judgmental comments of others?
2. Are you afraid of the ramifications of your elective surgery and how they can affect your personal life if undesirables find out?
3. Are you afraid that the news of your surgery may affect your job?
4. Are you concerned that your significant other may be upset with you should you decide to have a cosmetic surgery procedure?
5. Are you “thin-skinned” and concerned what others may think of you should they find out you have had a cosmetic procedure?

If you have said yes to any of the above, careful consideration should be made in determining who you should confide in, or if you should at all.   However, I do not suggest going this alone.  I feel that one needs a support structure for optimal healing.   During the healing period, highs and lows are to be expected and without a support structure (even a solitary friend who can be there for you), the lows can dip right into the deep end. Of course depending upon what type of procedure you have can determine if you will be able to keep it a secret at all. If you have a total makeover or considerable facial plastic surgery—it may be obvious.  You are under no obligation to tell anyone about your plastic surgery procedures. 

As for keeping your surgery news from your significant other, I do not condone this, but this is also not my decision.  I feel that if you must keep major events such as these from a loved one, then you are indeed betraying their trust to a certain degree.   In the event that something should happen, your significant other will need to know where you are and what you have gone through to help you.  If they find out after the fact, they may be very upset.  I know many believe that asking forgiveness is easier than asking permission, but I assure you, it may not be that easy if it is a spouse!

Keeping the rumor mill quiet at your place of employment can be a real challenge.  Everyone knows their coworkers love good gossip, especially when it comes to cosmetic surgery.  If you can take off at least two weeks of vacation time, this can help immensely but like I said, significant changes in facial features are hard to disguise with a simple change of hair color or haircut. Be prepared to be asked questions, even inappropriate ones.  Just know that a peaceful, non-threatening and comfortable workplace is your right, as well as your right to retain personal privacy without the onslaught of harassment by anyone for any reason.  If you ever feel uncomfortable as several of our forum members have, you have every right to demand respect and privacy. Don’t let anyone bully you into talking, or harass you constantly about, “I know you’ve had [this or that] done. Admit it!”  This is your body, not someone’s gossip fodder. Take a stand.

If you choose to tell, do so without fear of judgment. Make a point to be proud and show no fear.  Those who are jealous often react and prey upon our fears, so give them a smile and keep your chin up.

Telling children can be a different matter entirely.  They are going to notice eventually, don’t ever think a child is unobservant, they notice everything eventually even if they don’t come out and say it. It is obviously your choice to tell your child, but being matter of fact can be a good way to handle the situation.  Making it a huge deal with invoke curiosity and chatter, being nonchalant about it may not trigger much interest. So the amount of interest you wish you invoke is largely dependent upon the child’s age and personality.   You know your child best, you will figure it out.  Perhaps join the ladies on the Tummy Tuck forum , as they have had a lot of experience confiding in their children about their procedure.

If you have any great stories (or not so great stories) about how you let everyone know, or not know, or if you were “outed” by a friend, please post!

Injectables for Cheekbones

As many of you may already know I am pretty much obsessed with prominent cheek bones. I love full cheeks, not the fatty, puffy cheeks you see in overly fat-grafted patients, or even the natural, pudgy cheeks. But high, exquisite, chiseled cheekbones with a youthful, but not significant, fat layer on top of them catches my eye above most other facial attributes. In fact, I think one of the first compliments I ever gave my boyfriend before I asked him out (yes, I asked him out) was that he had really great cheekbones. They aren’t too bony so that his face looks gaunt, and not they’re not too plump either—they are just right. He must be incredibly tired of my complimenting him, “I love your cheekbones” as I trace my finger on his face. He just rolls his eyes and thinks I am nuts. I can’t help it.

So, if we don’t have beautiful cheekbones naturally, how do we buy them?? What does it take to create perfect, high cheekbones? Although I have pretty prominent cheekbones I have had my share of injections to make them more so. Unfortunately, it never lasts much past the swollen stage. Let’s look at the most popular options in injectable cheek fillers… •

• Radiesse: I have had Radiesse in my lips, and I don’t recommend it there, but I have seen it used for the jawline, cheeks and chin. The results have been pretty phenomenal although it did not last as long as they had hoped. It is certainly worth a look-see. The cost of Radiesse is still about $1,500. a CC.
• Sculptra: I have had Sculptra injected into my undereyes and nasolabials. I felt that it took too long to achieve nominal results for considerable augmentation. I honestly would not choose it personally, although I have seen fantastic results in those with lypodystrophy. The cost can be a few thousand over a course of 3-6 months.
• Restylane (also JuveDerm, and Perlane): Although I have not had Restylane in my cheeks, I have had it in the upper eyelid, undereyes, the nasolabials, and lips. I love it! It works. But you get a lot of swelling associated with hyaluronic acid injections and this can set you up for disappointment simply based upon becoming accustomed to larger cheeks/lips/etc. even though they are clearly larger in the after photos. I have seen Restylane used for the cheeks and feel it can give you a very nice result. It is also temporary so if you can’t stand it, you won’t have it forever. The cost for Restylane can run you about $900+ for 2 cc. but you may not need that much. Subtlety is a good way to start.
• Fat Grafting: I have had fat grafting twice and both times the fat layer disappeared in the areas I wanted to retain it and stayed in areas I did not like it. When you go slow, fat grafting can be very nice. It can enhance al already existing cheek structure, or it can smooth the harshness of implants under thin skin. Fat grafting can run you anywhere from $2000. to $6000. and may take several sessions.
• Artfil (formerly Artecoll): Microscopic beads of polymethylmethacrylate (or PMMA, the same material PlexiGlas is made from, can be suspended in a carrier and injected in several sessions to trigger your own collagen to grow. It can, however, take a considerable amount of the injectable to make a difference once the carrier is absorbed by your body. Artefil can cost about $1200+ for a cc.
• Cheek Implants: Although not an injectable, cheek implants are still an option. It can be used in conjunction with the above options for a natural result if you go to the right surgeon. Cheek implants can run you about $5000.-$10,000. depending upon whom you choose as your surgeon.

I have always been fascinated by high cheekbones so as their appeal has come and gone, they have always remained a favorite with me. I remember when the trend was to have plump cheeks. However, I felt it never made anyone look younger, rather they looked overstuffed to me (think Rene Zelwegger). When you take a stick-thin woman and fill her face with fat, it doesn’t look natural. But having a gaunt face can age you considerably. You may have heard of The Ogee Curve in facial aesthetics. This enhancement of the gentle concavity of the face, while maintaining a chiseled malar point is a delicate balance indeed. Choosing a skilled surgeon with an impeccable aesthetic eye can help you achieve this balance.

Just remember, a little bit goes a long way. Consider a temporary solution before undergoing a more permanent option. You can always go back for more, or decide on a permanent option later. I truly believe that slow and easy wins the race in plastic surgery. Reversing a bad mistake is far more difficult than avoiding one in the first place.