Thank you for your question.
You submitted your question with several photos.
And you stated in your question that you are essentially 18 days out after getting Restylane
placement in the cheekbone area.
And that you are concerned that there is still swelling and asymmetry.
And you stated that there was initially a significant amount of both swelling and bruising
that has gotten better and that when you have done research, you saw that most of this should
have resolved at 2 weeks.
And so you are concerned and you state that your doctor advised you to wait 4 weeks.
Well, certainly I can understand your cause for concern reviewing your photos.
And I can certainly suggest to you a strategy that might be relevant and should be discussed
with your doctor.
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.
The use of injectable fillers is a very significant part of my practice.
And helping people get nice looking cheekbones has been something of an evolution in my own
practice.
And I’ll certainly share with you my philosophy that guides how I essentially avoid situations
like what you are in currently.
So to understand first of all your doctor’s intention, your doctor wants to add volume
to compensate for volume loss.
And the general philosophy of fillers is essentially to place fillers within the skin which is
intradermal or under the skin, just below the layers of the skin which is the fatty
cell layer.
Now the challenge the way I look at facial aging maybe is what really guides my approach.
And I look at this area, particularly in the cheekbone area as a function of bone loss.
And so as a function of bone loss, the placement of filler more superficially can commonly
result to something of what you are experiencing now.
When I look at your photos, I see a very distinct outline of the filler particularly in the
right cheek area.
And it is often perceived as, it can look okay but if it looks obvious, then it’s
not so great.
And what is often a criticism is that the filler is placed superficially.
When it comes to these layers of tissue, we’re looking at very thin layers and superficially,
it’s relative.
So understanding that this filler was maybe placed in a way to try to mimic the appearance
of the cheekbone is something that is commonly practiced and we have seen patients with this
situation.
And essentially what I’ve done is I’ve dissolved the filler and I’ve started from
the beginning.
When I say the beginning, essentially what I do is a technique called Structural Volumizing.
And the point of Structural Volumizing is to address the volume deficit at the level
of the bone.
That means that through specific techniques, I place filler between the muscle and the
bone using something called blunt cannulas.
I also use a different type of filler.
I used fillers that are in the thicker category such as Juvederm Ultra Plus and Juvederm Voluma.
When placed at the bone level in a specific way, we’ve been able to actually achieve
very nice cheekbone definition with no evidence of irregularities, avoiding swelling and bruising
and ultimately getting very nice balance and symmetry.
Our patients very often, we’ll just give them the mirror and they’ll see the results
immediately.
And I can certainly tell you that it’s been a significant paradigm shift in my approach
to helping people with the same issues that you are dealing with right now.
So essentially, the solution is defined by defining the problem and the problem is bone
loss.
However, the majority of colleagues place fillers more superficially with the idea of
trying to mold and shape.
But when it’s under the skin, it’s a little less easy to manage creating that shape and
it’s a challenge to get it to behave in a way that is consistent and predictable.
So I think that this discussion should be brought to your doctor.
Certainly at this point in time, this degree of asymmetry and the appearance of swelling
is not optimal.
Therefore, it is up to you and your doctor to decide what to do.
It may mean some dissolving.
It may mean changing the strategy overall.
You know, I think this frustration that you’re experiencing is actually very common and we
see patients with this challenge very frequently.
A lot of times, people see others who have had fillers placed in their cheeks and they
don't like the result because they look too rounded or pillowy.
And with Structural Volumizing, I kept going back to it because working from the bone structure
itself is much more deeper and therefore, the layers of tissue over it prevents this
very obvious outline kind of appearance that is more characteristic of the material and
the layer in which it’s placed.
So I don't think you need to abandon your doctor.
Certainly if this is the first time you’re doing this, it’s important that you and
your doctor figure out what’s best for you.
But I think that it’s fairly straightforward to me that your anatomy is reflective of many
of your contemporaries where soft tissue loss, bone loss and thinner skin is kind of a set-up
for a limited volume correction unless the material is placed deeper.
I think that’s basically the strategy that I would employ for a person like yourself
in my practice.
So I hope that was helpful, I wish you the best of luck and thank you for your question.