The appearance of cheek bone definition is a highly desirable characteristic of people
we see 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.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculofacial Plastic and
Reconstructive Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
Over the course of my career, I’ve been performing facial cosmetic procedures such
as the full range of facelift procedures, 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:
Safety, Predictability, Convenience, Rapid recovery and Longevity
This 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 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.
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 with additional placement of filler then the patient
may feel conflicted about the decision to have a quote “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.
While I do perform cheek implants, often at the same time as another surgical procedure
like facelift, I inform patients prior to the procedure if this so they understand the
limitations of facial implants.
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 avoid for a more predictable 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 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.
I hope you found this information helpful...thank you for your question.