are cheek and chin implants really permanent
a sad reality of facial aging is the progressive loss
of youthful volume as you age the face loses
definition it becomes more flat and even sunken
in particular the cheek area and the chin areas are
frequently recognized as having lost significant volume
particularly when you take a look at your profile
it's very popular for many people to get fillers to address
their volume loss interestingly there are
many people who don't feel that the fillers are working as well as they want
or they get tired of going in frequently to have these filler injections
they experience swelling and bruising and
eventually develop filler fatigue and become interested in something more
permanent in their quest for a permanent solution
they become aware of facial implants they perceive that facial implants such
as cheek and chin implants are the permanent solution
they're looking for although these implants can appear to
look very good for several years there are important
age related changes that may not make this
option the best choice of having facial implants
for the long term as they may appear to be
i'll discuss how i adapted my approach to facial volume loss
from surgical implant placement to longer-lasting non-surgical solutions
in my practice I'm Dr Amiya Prasad I'm a Board-certified cosmetic surgeon
and Fellowship-trained oculofacial plastic and reconstructive surgeon
i've been in practice in new york city and long island for
over 25 years as a facial cosmetic surgeon
i perform all types of facelift surgery from short incision
mini lifts to extensive deep plane facelifts
i do perform cheek and chin implant placement surgery both
with facelifts and as standalone procedures
i also routinely perform non-surgical volume enhancement using injectable
fillers in the lips the eye area the cheeks jawline and
chin it's natural to assume that cheek and
chin implants are permanent because they aren't
metabolized like hyaluronic acid fillers while cheek and
chin implants which are usually made of a soft
silicone material are not going to be metabolized
your underlying facial structure is not permanent the same aging process that
causes the loss of facial volume which is primarily diminishing
bone volume as well as loss of fat muscle soft tissue and skin thickness
continues after facial implants are placed
this progressive loss of facial volume occurs at the
foundation of where the implants are anchored
like the cheek bone and the chin while it's common practice for the cheek
implants to be stabilized or anchored in place using titanium screws
or bolsters for stabilization in order to maintain a
desired position there will be continual changes of the
natural anatomy including the bone muscle fat and
surrounding tissues this progressive change can result in a
disproportionate appearance of the facial implants
relative to the rest of the face as there is progressive fat loss below
the skin and the skin becomes thinner it's also possible to see the actual
outline of the implant these issues also apply to chin implants
although usually not as significant recognizing the presence
of natural asymmetry and subtleties of contour the implants often have to be
modified during surgery this typically involves shaving
the silicone and observing the effects on the facial contour
this becomes particularly challenging because of normal
intraoperative swelling due to the presence of anesthetic
and natural reactive tissue swelling further there are other soft tissue
aspects which cannot be adjusted for by carving the implants so
postoperatively to optimize the appearance
it can still be necessary to employ the use of soft tissue fillers
to help optimize the longevity and resilience of hyaluronic acid fillers
the makers of hyaluronic acid fillers introduced
new fillers such as Juvederm Ultra Plus and Juvederm Voluma although these
fillers were a major step in the right direction a
common source of frustration is that in spite of the filler's improved
viscosity and longevity people who want to have better cheek
definition and chin definition end up looking soft and doughy
the doctors who place these fillers are also frustrated because when they place
the fillers under the skin and intentionally
mold the fillers to look like cheekbones and other facial structures
unfortunately the look they achieve in the office does not last
since conventional placement of hyaluronic acid fillers result
in the fillers migrating there was a clear need
to place the fillers in a way where migration would be
less of a problem in some ways this is comparable to cooking where you
have the right ingredients but what you need is the
right technique fortunately the right technique in my
opinion has been developed by adapting strategies and anatomic
knowledge from facial implant surgery when we look at relative proportionality
of volume loss associated with facial aging it's
clear that the most significant impact is at the bone level this is why
facial implants are placed on top of the bone structure
this of course begs the question why are soft tissue fillers to improve
facial structure placed just below the skin level
it should be no surprise that these fillers end up
being displaced and creating the stereotypical "pillow face" appearance
this means that there needs to be a consistent and predictable
method to place long-lasting filler at the bone level to take advantage
of the strong foundation and the intrinsic
shape inherent to the bone structure although many of my colleagues and
non-physician injectors believe that they are placing
filler at the bone level when they do a
demonstration and show how the needle they're using is
hitting the bone they're not really delivering the filler
into the space that optimizes an enhanced structure
in addition these well-meaning injectors doing these demonstrations
repeatedly pierce the skin with their needle thereby
inducing more bruising and swelling than would be necessary i
employ a technique called Structural Volumizing
since i'm creating more definition by placing
volume on the bone structure i believe by placing this thicker and
longer lasting filler using blunt cannulas instead of needles
i'm able to deliver the material i want into the spaces above the bone in a
smooth almost frictionless way reducing the risk
of bruising swelling and other potential complications
i'm essentially performing a non-surgical treatment
by applying my surgical knowledge to place the filler
at a deeper level my patients are typically
very happy about how good they look immediately
and rarely have any concerns about bruising and swelling the next day
by placing the filler mostly at the bone level
i can be more conservative with the volume
if i need to place any filler below the skin level
to address any subtle contour issues by using this approach of placement in
limited quantities below the skin the filler is less likely to be
displaced i usually see my patients again after
two weeks to see how they look after everything is settled
something worth mentioning is that if there is any issue with the facial
implant then surgery is necessary to remove or
exchange the implant with structural volumizing even at the
bone level hyaluronic acid filler can be quickly
dissolved by using the enzyme hyaluronidase
when considering cheek and chin augmentation for a more
youthful appearance remember our facial dimensions change with age
but the facial implants don't by using thicker hyaluronic acid fillers
placed by applying the principles of facial implant surgery
we achieve the same results in many situations as a surgical procedure
with greater flexibility and precision with lower risk while fillers do not
last as long as surgical implants they do last
longer than they did previously and are certainly
far more convenient for my patients i've also observed that many people who
would have otherwise objected to undergoing any
kind of facial implant surgery are much more interested in having
Structural Volumizing because of the convenience safety
predictability and reversibility i hope you found this
information helpful thank you for your question
you