Thank you for your question.
You submitted a single photo and you state in your question that your left cheek is completely
different from your right cheek and you’re wondering whether it is the bone or whether
it is fat or both.
And to go on, you also mention that you are planning to lose more weight and you want
to know how to fix this problem.
Well, I can certainly discuss this question with you based on the type of approach I have
in my practice for similar situations.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years and I can tell you
that this concern about symmetry is a concern that pretty much every patient has to some
degree or another whether they are interested in eyelid surgery, facelift surgery, or injectable
fillers or anything else.
They are always aware that there is a difference between one side and the other.
They can’t always understand exactly what but certainly they recognize there is asymmetry.
So what is the basis for this asymmetry?
Well, one simple basis is the fact that most people are genetically asymmetric to some
degree.
Some people are more asymmetric than others and basically when you think about one side
of the face from the other side, there is a relative microsomia or just a little bit
less projection of the bone structure on one side compared to the other.
So, it’s very common to have one cheekbone more prominent than the other or the projection
forward being different from one side than the other.
So basically the foundation is the bone structure.
Now above that bone structure is of course the muscles, the fat, the skin, the soft tissue
essentially.
And so in a situation like yours, understanding that you are planning to lose more weight,
there is a high likelihood that there will be a change in the relative volume of cheek
material or mass on the right side and you may get some degree of relative symmetry because
the right cheek looks a little bit more full than the left cheek.
Now, very often, when people are losing weight, as long as they are within 5-10 pounds of
their ideal body weight, it is usually in a place where they are going to be steady
for a long time unless they are somebody who is more of an athlete who does things like
marathons or triathletes or someone who really burns a lot of fat and has a very low percentage
of body fat.
Most people with regular work and regular lives and relatively good diets usually floats
somewhere around 5-10 pounds of their ideal body weight if they are into fitness.
Now that being said, that usually means there is some degree of fat in their face which
is normal.
So when it comes to trying to balance things out, we usually do some variation of fillers
and these fillers can be placed at different levels in the face and one area that we really
find very helpful is a technique called structural volumizing.
In structural volumizing, we are actually placing filler, a thicker filler like Juvederm
Ultra Plus or Juvederm Voluma® at the level of the bone.
By doing that, we are able to place it under the muscle and in fact restore or augment
the volume at the bone level which means to a degree, we can compensate to some of that
asymmetry where there is a relative deficit on one side compared to the other.
Now, we can also place the volume in the soft tissue but as a general rule of thumb, when
it comes to the cheek, I try to do more at the structural level because then it is more
stable and the muscles and soft tissue glide over that material as opposed to placing it
in the soft tissue where the volume has to be limited to a certain amount before it creates
a weight or pushes down or spreads out or may look a little bit irregular.
There is an art to the placement of fillers and there is also an art to choosing the type
of filler.
We are actually living in a very good time in the world of fillers because for example
the hyaluronic acid fillers whether it is in the Galderma family, Restylane products
or the Allergan family of Juvederm products, we have a lot of options from different viscosities,
different particular properties and different ways to actually apply these fillers so with
this comes with a lot of flexibility but further requires a true understanding of the art of
placement.
I can’t tell you how much every day in our practice people come in, when we are discussing
fillers, they always talk about how they don’t want to look like such and such and so and
so because they don’t want to look ballooned or unnatural.
But I also point out is that what you don’t know is that people look good and have fillers
because they look very natural and so that again is about the art of placement and the
art of understanding the proportions something like the Golden Ratio where there is a natural
balance to their face that you want to achieve to maximize an attractive look regardless
of ethnicity which is remarkable.
The Golden Ratio is almost universal.
So that being said, I think it make sense for you to meet with qualified, experienced
doctors who does a lot of these fillers who you feel is able to understand your concerns
and see what kind of strategy would work best for you.
I think it is very important that you get comfortable with one doctor who you feel really
gets what you want and is able to achieve.
And that’s for me, in my practice, I spend a lot of time with every patient.
I take their pictures, I put them up on the screen and look at them very critically and
we look together and we plan things out and I treat fillers pretty much the way I treat
surgery.
It’s all about really good planning, markings and placement and then achieving the optimal
balance not to mention, we follow them up in 2 weeks to check to make sure that everything
looks good or if an area needs to be tweaked, that it can.
So again, meet with qualified, experience physicians who do a lot of fillers.
Discuss your weight loss plan and see how that fits in the context of your concerns
and move forward.
So I hope that was helpful, I wish you the best of luck and thank you for your question.