Question

Hi Dr. Peter,

I am an active, 44 years old female. Recently, my face seems to be getting skinnier and more gaunt. Comparing my latest photos against photos of me in my 20’s, I seem to have lost volume around my cheek area. This makes me look haggard, bony and I think my cheeks seem to have sagged.

What non-surgical options are there to restore my sunken cheeks? I’m not ready for invasive procedures at this point. Please share the process, its longevity, and post-treatment aftercare. Thank you.

Susan

Answer

A lot of patients underestimate the importance of full cheeks and how its plumpness can lend to a youthful appearance. 90% of the time, people do not realize what the problem is, and why their face looks so aged. In fact, deflated cheeks can cause one to look many years older.

Before we share how dermal fillers can restore the plumpness in your cheeks you had before, let us first identify the causes of facial volume loss.

What causes facial volume loss?

Three factors cause facial volume loss as we age – bone loss, muscle atrophy and thinning of the skin.

Bone loss or bone resorption refers to decreasing bone mass due to advancing age. Just like how our upper and lower teeth will overlap one another as we age, our cheekbone and skull suffer from bone resorption too.

Secondly, our facial muscles and fat will atrophy (or shrink) as we grow older. Unfortunately, this is the opposite of our stomach and flanks. The stomach area is prone to pack on more pounds due to a slower metabolic rate.

Thirdly, our skin thins out. While we gradually lose volume in the dermal layer, this loss is not as significant compared to bone and muscle degeneration.

Thankfully dermal fillers can restore the loss in facial volume effectively and within minutes.

What are dermal fillers?

Dermal fillers are gel-like substances injected below the skin to plump up different layers of the skin. Hyaluronic acid fillers are the most popular fillers used in the market today.

To add volume back to your cheek or midface, we need to use a thicker dermal filler that can lift, contour and hold the shape of the cheek.

Furthermore, the type of dermal fillers used largely depends on the treated area. When treating under eye hollowness and dark eye circles, a lighter filler is preferred. Fillers for under eye should not conform to a shape to avoid lumpiness.

But when we treat cheeks, we need to lift saggy cheeks to its original position. Hence, the molecules of the filler must be highly cross-linked. The more cross-linking there is, the firmer the filler feels.

How do I know that I have facial volume loss?

Only trained doctors are equipped to assess if you have facial volume loss.

When we assess a patient, we find that not all patients require filler injections to address the volume loss. This is especially true for patients with a round face or chubby face. By injecting more filler, this will aggravate the patients’ overall appearance.

Moreover, everyone experiences volume loss in different areas. Some patients may lose volume just at the temples. Other may experience hollowness at the frontal region, below the eyes, mid-cheek or lateral cheek. The loss of volume at the mid-cheek can make nasal labial folds more prominent, and jowls to appear below the jawline. Besides, bone resorption can cause the chin to appear weaker too.

As such, injector must put the right volume in the right place. Putting fillers where it is not needed can worsen jowling, marionette lines and all the other aesthetic concerns associated with aging.

How are dermal fillers used to restore cheek volume?

To treat cheek volume loss, dermal fillers work by replenishing the lost volume and by lifting saggy cheeks. Dermal fillers injected into the cheek will help to correct facial asymmetry, improving facial harmony and accentuating contours to your face.

Before we treat a patient, we will assess the patient to identify the area of concern. If volume loss in the cheek is due to bone resorption, then the dermal filler is injected just above the bone. We will also inject highly cross-linked filler with harder consistency to create shapelier cheeks.

But if we find that the volume loss is around the fat, skin or dermis, then the filler is injected more superficially and further away from the bone. Here, we will use softer fillers that are less cross-linked.

Generally, volume loss on cheeks can be classified as either a hollow mid-cheek or a hollow lateral cheek. Both of these concerns are corrected using a combination of deep or superficial injection techniques. Normally, we use a cannula to correct cheek volume loss. Unlike a needle, a cannula has a blunt end and does not cut through blood vessels.

How much dermal filler is used for cheeks? I do not want to have “flying saucer cheeks”.

How much filler needed to restore the cheek really depends on how much volume loss there is. The underlying concept adhere serves to restore the volume loss. By all means, we do not over treat the area.

Rest assured that you will not look puffy unless you are over-injected. This makes the diagnosis very important as the injector will determine the optimum volume needed. Furthermore, the injector must know where to place the fillers. For example, the filler must be injected into the right plane (or layer of skin). If the volume loss is at the superficial layer, then the fillers should be placed superficially, as opposed to injecting deep.

So based on this principle, we assure you that you will not end up with flying saucer cheeks or chipmunk cheeks, post-treatment.

How long do the effects of dermal fillers last?

The longevity of fillers depends on how cross-linked the filler molecules are. Fillers that are minimally cross-linked last between one month and up to 1 ½ years.

How long the filler lasts varies from one person to another. It also depends on how fast the body metabolizes the filler.

The good news is cheek fillers can last between 12 months and up to 2 years. This is because our cheeks are less dynamic, as compared to our lips which are constantly moving.

What should I do and not do after filler treatment?

Post-treatment, do not rub your face roughly and avoid facial massages. Apart from that, you can resume your daily activities. Feel free to sleep and wash your face as usual. Plus, you need not sleep upright after treatment.

In short, cheek filler restoration does not come with any inconvenience or downtime.

Who is a good candidate for dermal fillers?

Anyone with volume deficit is a good candidate for cheek volume restoration with fillers. The medical aesthetic field is truly liberating whereby we do not limit treatment based on age. For example, a teenager seeks treatment to correct an asymmetrical face. If the teen or parents feel that correcting the imbalance will boost the teen’s self-esteem, we would assist with the treatment. We do not judge our patients in any way, be it age, gender or any dimension.

After all, restoring our patient’s confidence is our ultimate goal.

Conclusion

If you have never been treated with fillers for sunken cheeks, you would be positively surprised with the treatment results. Simply because dermal fillers can plump the hollows, lift and reposition the loss volume where it once was in your youth.

The outcome of any cosmetic treatment very much depends on your doctor’s interpretation of beauty and his or her aesthetic eye for symmetry. That is why you should not be lured by attractive prices beauticians or non-certified doctors offer. Seek treatment only from trained medical doctors who know the facial anatomy well. We find it truly rewarding when our patients walk out of our clinic looking upbeat and more confident. And seeing what we can do for our patient’s self-esteem motivates us to give you our best.

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