Thank you for your question.
You submitted your question with a single photo of you smiling.
And you’re stating in your question that you’re 38-years old and that about 6 weeks
before your wedding, you’re planning to have some Voluma placed in your cheeks.
And essentially, you want to address some lines in the cheeks, at the same time, you’re
concerned about it looking natural.
And you’re also expressing a concern about the cheek looking more deflated when the Voluma
gets absorbed or broken down by the body.
Well, I can certainly help you understand this type of question which comes up in our
practice pretty much every day.
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.
And I use Juvederm Voluma as well as many other hyaluronic acid fillers in my practice
every day.
And we actually perform a lot of procedures for cheek enhancement.
So I’ll help you understand a little about your concerns.
So to begin with, at 38 and since you just submitted a photo with you smiling, it’s
difficult to assess what the face looks like at rest.
But understanding that if you have an interest in addressing cheek volume, chances are when
your face is at rest, there is some volume loss.
So what I try to help my patients understand is when you are doing a procedure to restore
volume in the cheeks, well, that’s what you’re doing, you’re restoring.
You’re not necessarily augmenting.
You know, there’s a very big difference between talking about someone who has already
full volume in the cheeks and high cheekbones and then augmenting because that’s an augmentation.
I like to think of it, when we’re talking about restoring volume and maybe enhancing
as more as a correction.
With that understood, you can appreciate that it is unlikely, if you’re going to stay
within a limited amount of correction, that your skin will stretch out and I think that’s
what concerned patients have expressed to me.
They’re concerned that once they’ve started having fillers that they’ll always have
to keep doing them and they are afraid that if they stop doing them, that they’re actually
worse off than when they started.
The reality is that you don’t stop aging and depending on the genetics and other factors
that are more environmental such as cigarette smoking, diet, etc., you will still continue
and time will march on.
But as far as being overstretched, it’s not likely.
If you’re wondering if it’s worth it, well, I think that when you meet with your
doctor and this is basically my process, what I do is I take pictures of my patient from
different angles and show them what they look like when their face is at rest because that’s
what we’re treating.
We’re not treating a face that’s moving, we’re treating a face at rest.
And so when we do that, especially when we’re talking about cheeks, it’s very important
to understand exactly where the volume needs to be corrected.
We do a procedure called structural volumizing which is a very elegant approach to enhance
cheek volume.
And the reason is that, when we think about volume loss, we’re talking mostly about
bone as well as some fat volume.
And so when this placement of a filler such as Juvederm Voluma or Juvederm Ultra Plus
is at the bone level, then the cheeks look structurally more defined and they’re enhanced
to the level where they look natural and at the same time, they don’t add weight so
that you avoid that kind of chipmunk look when you get filler placed just under the
skin.
So for me, this technique really ensures for my patients the optimal appearance that looks
natural which then gets to the point of really the art.
The art of placement, the art of the vision of what you have as far as the outcome and
what your doctor has is very important.
When we do cheek volume enhancement and after I’m done and my assistants and I always
has this back and forth where we want to be sure.
While I’m placing it from one angle, I ask my assistant what they think from another
angle and they’ve really worked with me for a long time and we have this really nice
dialogue.
Once we get the right volume correction and we like it, very often the patient looks at
the mirror and they’re just thrilled and they really love that.
So, I’m certainly very much a proponent of restoring a youthful nice look by the right
volume in the cheeks.
But I think this is a discussion you should have with your doctor to assess what is a
good correction.
I always tell my patients that it’s better to undercorrect than to overcorrect.
And so we can always add which means that I usually have my patients come back after
two weeks to reassess them.
In terms of concerns about bruising, well with structural volumizing, through the techniques
that I employ, basically bruising is not an issue.
So the bottom line is discuss these concerns with your doctor before you move forward with
the injection.
Understand that a limited amount will not overstretch the skin but that normal facial
aging does continue and you’ll decide as time goes on whether you want to continue.
So I hope that was helpful, I wish you the best of luck and thank you for your question.