Thank you for your question.
You’re asking a question about volume when it comes to recreating or creating the effect
that you would get with a cheek implant with an injectable filler versus fat transfer.
And you’re asking if there are more permanent solutions for cheek volume, why wouldn't someone
choose a more permanent solution such as a cheek implant or fat grafting as opposed to
getting filler as you would describe every 2 years.
And then you add your question, does technique matter?
Well certainly, I can discuss this for hours but I’ll give you an overview as to how
I counsel my patients who ask exactly the same question pretty much every day in our
practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
I perform all those procedures that you describe, everything from cheek implants to fat grafting
as well as the use of injectable fillers.
So I can share with you basically what my own personal evolution has been in determining
what I think is the recommendations or inform the recommendations I make to my patients
every day in my practice.
So to begin with, it’s very important to understand that the concept of permanence
is a fleeting concept because our faces continue to change.
And it basically, in terms of an evolution, I would say that before we had such a good
variety of injectable fillers, my natural inclinations particularly as a surgeon was
to recommend the placement of cheek implants and then well into early to mid 2000s as well
as offer fat grafting which was once the permanent or I should say longer lasting filler came
along, I evolved and I’ll explain why.
As I said earlier, permanence is not truly a long-term solution because when you think
about “permanent solution”, you can look at people who had silicone injections done
20 years ago and how they look now.
You can look at fat grafting 10-15 years ago and now.
You can appreciate that facial aging is a progression of volumetric loss most significantly
at the bone level.
And because it’s at the bone level, it’s very important to understand the impact it
has on the facial structure.
Now certainly cheek implants are certainly a very good strategy when it comes to providing
volume correction.
However, when you think about the options of let’s say a cheek implant versus a fat
transfer versus filler, well it also has to do with relative indication based on skin
thickness and the type of individual we are treating.
So when it comes to the solutions that patients ask me for, I’ve ultimately gravitated and
I have seen a very high success rate with something called Structural Volumizing.
And the point of making that statement also has to do with the lifestyles of our patients.
When I was in training back in the 90s, I recall that my preceptors who were amongst
the top cosmetic surgeons in the country, were essentially of a particular mindset where
the type of patients that they were treating as a large percentage were people of significant
affluence who would undergo a lot of procedures and then hide for weeks and weeks.
Move the clock forward and then the modern patient often, even if they are affluent or
not, they’re very busy and they have lot of responsibilities and they cannot hide for
weeks and weeks.
So in terms of lifestyle and in terms of predictability, there is a high premium to getting the optimal
procedure with minimal risk and maximal predictability with almost no tolerance for complications.
So when you think of the equation in that respect, we also have to think of the equation
in terms of the level in which fillers are placed.
A lot of times, people who go for the solution of fat grafting are very disheartened by the
lack of predictability of fat grafting.
And in spite of significant improvement in the processing of fat after harvesting, there’s
still a significant unpredictability to fat grafting in my experience and in my opinion.
So between fat grafting and fillers, fat grafting and fillers are typically placed just below
the skin in the soft tissue of the cheek.
What that unfortunately can result in is a rounding and an over filled exaggerated and
unnatural look.
This is where Structural Volumizing comes into play.
If we use the same principle that’s applied for the placement of a cheek implant which
is placed directly on the bone structure and we use that same concept but place filler
that has a certain thickness to it on the bone structure between the bone and the muscle,
well then you can get a effect that’s comparable to a facial implant but by avoiding surgery
and avoiding the potential issues related to placement of facial implants.
You can get essentially the most predictable outcome with the lowest risk.
Further, a lot more people are willing to undergo fillers than are willing to undergo
cheek implants.
So when it comes to my practice, currently we do a lot of Structural Volumizing.
And to be more clear, essentially what I’m using is a special instrument to place a thicker
filler such as Juvederm Ultra Plus or Juvederm Voluma at the bone structure level.
I am able to enhance the cheeks, the jaw angle, the chin, the jawline and I can do all this
in a matter of minutes such that someone can have the results and look like they’ve had
a facelift without undergoing surgery and that’s a significant advancement in the
whole strategy of helping people look their best in the least amount, with the lowest
risk and the least amount of time.
So in the closing of your question, you asked does technique matter?
I would say absolutely.
Technique definitely matters.
So I think it’s important that you learn this in terms of your strategy depending on
what is right for you.
If you’re more amenable to having cheek implants, certainly that’s a very viable
appropriate option.
I would probably discourage you from fat grafting because of the challenges with predictability
and asymmetries and irregularities but again, that’s my opinion.
And I would say that for most of my patients who come to my practice and have a similar
type of concern, we pretty much end up going to Structural Volumizing and getting the results
that in so many ways is so convenient to a patient’s lifestyle, it’s hard to choose
something else.
So learn more about these options including the concept of Structural Volumizing which
will further I think enhance the depth of your understanding of the role of injectable
fillers and why very rational smart people choose something like Structural Volumizing
instead of a more permanent solution.
So I hope that was helpful, I wish you the best of luck and thank you for your question.