Thank
you for your question.
You’re 24-years-old and you’re noticing the malar creases are getting deeper over
the past year or so.
And you are describing your lifestyle as being generally healthy which includes eating well
and not smoking.
And so you’re looking for some suggestions as to what to do to help this area.
Well, I can certainly share with you how I would have a discussion about this type of
situation which pretty much occurs 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.
Helping people with facial appearance whether it’s from just genetic or aging changes
is a core of what I do in my practice every day.
So I think that when I look at a situation like yours, I basically look at what is the
balance of the facial anatomy.
And essentially when someone is young and is concerned about a relative deficit in an
area of their face, it’s obviously not due to facial aging.
It’s essentially a genetic trait.
Now, it’s not anyone’s goal to try to make everyone look the same but when someone
has a concern about an area, I basically take photos and I review with them what are the
elements of the facial anatomy that contribute to this appearance.
And everything with what we do in the practice of aesthetics has to be based on a foundation
of anatomy.
So when I look at someone who has a concern in this area, the malar crease area, essentially
what we refer to this is a midfacial deficiency.
Now that doesn't mean that there’s anything really wrong but it’s just an area where
there is a deficit of bone projection and soft tissue projection.
So when it comes to possible ways to improve this area, my goal is to discuss different
types of injectable fillers as well as different methods.
One of the things that gets a lot of people confused as they do research in this area
is that they get barraged by the name brands of different types of injectables and essentially
find themselves looking for the best injectable.
And I would state without any reservation that it is not about the best material, it’s
really about the doctor who uses the material and the judgement applied to placement of
the material.
Essentially, in my practice, we overwhelmingly use fillers from the two major filler companies
or I should say brands.
One is the Restylane family of fillers and the other is the Juvederm family of fillers.
And so, in a situation like yours, I would apply some of the same methods and principles
as I do for facial aging.
Facial aging is essentially a combination of different areas of volume loss, in particular,
bone loss.
So when someone has facial aging, I employ a technique called Structural Volumizing.
Structural Volumizing is applying the principle of correcting volume deficit at the bone level
using a long lasting and robust filler such as a Juvederm Ultra Plus or Juvederm Voluma.
Placement matters.
Level of placement matters.
Volume of placement matters.
So when I place volume in the mid face at the structural level which is between the
bone and the muscle, the skin doesn't look like it’s ballooned or puffy.
A lot of people come in and are very concerned about not looking like, choose the celebrity
that you don't want to look like, who has a rounded appearance.
And even though they are healthy and very lean, their face looks pillowy.
Well, when you do Structural Volumizing, placing it at the structural level of bone, you’re
not going to get that kind of result and that will look more natural.
Now is there a potential value in placing volume in the soft tissue or the area below
the skin at the fat cell layer?
Of course there is.
This is an art.
And so it’s basically sculpting in a way of placement.
So I would place the material at the bone level as well as in the soft tissue level
to try to achieve a nice, natural contour so it doesn't look like someone has had a
procedure.
People are always critical of fillers particularly in the mid face because they feel like everyone
looks very rounded.
And what I always respond to when they say that, is that you don't really notice it when
people had it done well because it looks natural.
So I think that for your question about the crease, essentially, it’s a reflection of
a relative volume deficit.
And therefore, it’s more of a reflection of a particular attachment to the skin called
the ligament.
And without having to go further to the technical details of that, I think it’s just important
for you to understand some basic principles of correction and the importance of finding
a doctor who is skilled at this type of approach.
I think it’s important for you to consider that as a way to address this issue with the
understanding that the goal is to have improvement and not to change your character, the character
of your face too radically so you avoid it becoming obvious.
So in closing, meet with qualified, experienced physicians and learn about your options and
learn about what your desired outcome will be and then see how that works out for you.
In my practice, I routinely have my patients come back after two weeks after injectable
fillers so I can see how they look and see what volumes and placement areas worked best
for them as well as what can be opportunities to make the areas look even better.
So I hope that was helpful, I wish you the best of luck and thank you for your question.