Thank you for your question.
You submitted several photos and you have essentially concerns about volume in the cheeks
and the tear trough.
And you’re asking about strategy in terms of difference between treating a man versus
a woman as far as the areas of placement and what your options are.
Well, this is a very important question and I think that it’s something that I’m quite
familiar with doing this every day in my 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.
Enhancing the facial structure through different modalities has been an evolution in my practice
over the past 20 years.
And I would like to first address the thinking before we talk about the solutions.
So one thing to be mindful of is of course to look at yourself and determine if this
is an area of concern due to weight loss, aging or is it just something that has always
been a relative deficit that you were born with.
Now that’s a very important way to make a distinction about how to strategize the
type of volume correction because the goal ultimately is to help you look better and
to look natural and I think that’s the origin as to why you’re asking of course the difference
between doing a cheek augmentation and tear trough augmentation in a man versus a woman.
The last thing you want is to look like many people fear thanks to some celebrities who
look very rounded, very doughy or pillowy.
The key is to maintain a natural masculine appearance but at the same time not to look
drawn or gaunt.
So when I was first in practice and for many years, basically, before the introduction
of hyaluronic acid fillers, the approach was to always use some kind of a facial implant
whether it was a tear trough implant, a cheek implant or a combined implant.
It was basically the strategy of a surgeon to place an implant.
Now move the clock forward to the last couple of years, we actually have fillers that are
longer lasting such as Juvederm Voluma, Juvederm Ultra Plus.
However, one of the challenges is where exactly to place and in what anatomic space.
A lot of times, people get frustrated, before they have come to us about the placement because
most of the time, doctors will place the filler only in the soft tissue spaces which means
just below the skin.
In our practice, we do something called Structural Volumizing.
This is a very distinct approach and unique in that we’re placing the filler at the
level between the bone and the muscle essentially the space which gives you more structure and
does not create this rounded look.
It’s not saying that soft tissue is invalid and certainly, there are many patients whom
I combine the two.
But placement on the structural level, at the bone level is a very specific method and
technique.
Now when I do this, I also keep in mind of course what the patient’s concerns are but
I think a general idea to at least understand a little bit more is a concept of the golden
ratio.
When you look at attractive faces whether it’s men or women, there is a certain balance
to the width of the cheekbones versus the width of the jaw.
And that balance is essentially a 1.6 to 1 ratio.
And there are different parts of the face where this 1.6 to 1 ratio.
It’s also known as phi or the golden ratio.
It’s derived from Greek.
And it is seen throughout nature and it resonates with people as it is hardwired in our DNA
to see that balance as being attractive.
So when people look drawn or gaunt or have a relative deficit, strategic placement can
be very effective.
We have to have a strategy.
We also have a wide range of injectable fillers to choose from whether it’s in the Juvederm
family or the Restylane family.
We have a lot of options in terms of relative thickness, the stretchability and memory as
well as the thinness and elasticity and diffusibility of these different fillers.
So we live in a very fortunate time.
It’s like being an artist and having lots of different paints.
You actually have a lot to use to customize.
The discussions with your doctor are critical.
When I talk to my patients, I take a lot of pictures.
I review their pictures with them.
They often discover different areas and aspects of their face that they didn’t realize because
they were focused in one area.
People always do this.
They look in the mirror and they focus on an area that bothers them and sometimes miss
the forest for the trees.
So after reviewing their photos, I actually just draw with erasable marker and I show
them where I think the volume would be of value.
After that’s done, we then decide what fillers to use and the patient decides what they like
to do and maybe what they like to wait to do but it is a strategy.
And certainly, there is of course a difference in how we place fillers on men versus women.
I think that in terms of the central facial area, men tend to more likely to prefer a
flatter look and women tend to prefer a softer look.
But again, there is a lot of variation there.
My preferred approach now is not to put facial implants in those areas but rather to use
long lasting fillers.
These long lasting fillers can last up to two years for example Juvederm Voluma.
So when you think about that, there’s a benefit of longevity and not having to come
to the office every few months and I feel what’s more important for me is the control.
I can really be very precise if one area of the face has more projection than the other
area of the face, one side versus the other which is very common, then I can add a little
bit more in one side compared to the other.
This flexibility is so liberating and it is so nice to be able to do that.
And we spend a lot of time in doing these procedures.
We never rush through placement of fillers.
I always treat placement of fillers like I do surgery.
We use extremely sterile technique and we do things in a very formal way to minimize
potential issues and to give the patient the appropriate amount of time in order to get
an optimal result and that’s how we work.
And generally speaking, it has worked out very well.
The convenience of having the procedure where you can get facial volume, Structural Volumizing,
performed in 30 minutes with just a little bit of local anesthetic and almost always
no bruising or minimal bruising, it is great.
This is a significant contrast to a surgical procedure where there’s going to be a certain
amount of healing process.
It doesn’t mean that there’s no value to cheek implants or tear trough implants
but I think that as an initial process, the injectable filler placement ends up being,
not only the initial process but it becomes the preferred process for our patients.
It can beat the convenience and the ability to just not to have any downtime.
So meet with qualified, experienced doctors.
I think surgeons have a unique perspective because a facial cosmetic surgeon has operated
at the bone level, has seen everything.
And I think that there’s a certain informed view of placement that’s going to be different
from someone who hasn’t done that type of work.
And of course, this is an area that people get sensitive about but that’s my perspective.
So I hope that was helpful, I wish you the best of luck and thank you for your question.