Thank you for your question.
You submitted a single photo and state in your question that you have an indentation
in your cheek after the resolution of an infection and you want to know if that indentation can
be treated.
Well, I can certainly give you some guidance on how I approach patients like yourself in
my practice.
A little bit of background, 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 and dealing with
all kinds of facial infections and issues with rehabilitation has been a significant
part of my practice for a variety of areas of specialty which I practice.
So to begin with, when we talk about this indentation, we have to essentially analyze
what is the cause of the indentation.
And when we look at the anatomy of that particular area in the mid-cheek area, you are looking
at of course the skin, you’re looking at below the skin, the fatty tissue below the
skin.
And chances are after that because of the infection, there was loss of volume.
At a more superficial level, if you could think of problems such as cystic acne, there
is loss of tissue which results in indentation such as acne scars.
In your situation, there is a loss of fat and soft tissue underneath the skin.
What also makes this particular area a challenge to correct is that there is nothing to push
against when you’re talking about adding volume.
Now what do I mean by that?
Well, let’s say you had an indentation over the cheekbone, well there is a bone underneath,
so if you want to put a filler, you can actually push against that bone.
So when we do something like structural volumizing, we are placing filler on top of the bone and
it accentuates the bone structure.
When we are talking about the area of this mid cheek area, without the benefit of a physical
exam, it is a little bit difficult to say exactly but chances are there are scarring
and there are some adhesions underneath that depression.
So, I think that your choices basically fall into two categories: injectable fillers that
can be performed in an office setting with some release of the underlying scar tissue
and then the other option is something such as fat grafting which would be harvesting
fat from one area of your body and placing it to this area.
Now, I think that we have to always understand that when we are talking about correction
in this area, in an area like this, you have to look more in terms of general improvement
instead of thinking of a 100% correction.
And the reason is that if you put an injectable filler in this area regardless of the relative
thickness of the filler whether it is as thick as Juvederm Voluma® which is one of the thicker
hyaluronic acid fillers or a filler like Radiesse, you have to think about how much volume filler
you can place before that filler starts to spread out or before it pushes and you are
not getting the full correction.
So a lot of times, I tell my patients that even when we are doing injectable fillers,
it’s a process where we might be able to build upon the effect as time goes on.
Injectable fillers by nature do stimulate some degree of local collagen production and
there is variability in terms of what an individual patient can generate.
It’s kind of like muscle building.
You know everyone can stimulate an area of muscle by lifting but different amounts muscle
growth occurs.
So understanding that, we also have to think about the more so-called permanent solutions
such as fat grafting.
The attraction to fat grafting is that you are literally replacing tissue that is lost
with tissues that is more native to that area.
What are the downsides?
Well, like I said when an area has had infection and scarring, the vascularity is not going
to be the same as it was prior to the infection.
So in my practice, I have actually prepared tissue that I want to do a grafting procedure
using something like platelet-rich plasma (PRP) or platelet-rich plasma (PRP) with Acellular
matrix.
Acellular matrix is a wound healing technology that has really made a difference in my practice
in helping rehabilitate skin that has been traumatized from a trauma like a motor vehicle
accident to traumas from surgery as well as infection and it just so happens, what I feel
is the next phase of medical progress is in regenerative medicine.
So I’ll actually prepare tissue before I do some kind of grafting.
So that being said, I think what you should do is find a physician, a surgeon, I would
say, I would lean towards surgeons because surgeons can do both injectable fillers and
a surgery such as liposuction and fat grafting.
And I would say that just try to feel through what is an acceptable benefit and risk that
you are willing to take.
I think that you also have to understand that regardless of the procedure, it is not going
to be likely to be a single point of correction.
It is going to be something that requires some follow-up and repeated treatments.
So, like I said, I think do some research, find a doctor that you feel comfortable with,
learn about your options, learn about what the treatment plan would be and then pursue
the correction of this issue.
So I hope that was helpful, I wish you the best of luck and thank you for your question.