Thank
you for your question.
You have submitted a question without any photos.
However, you state in this question that you have undergone 4 separate surgical revisions
for cheek implants over the course of 25 years.
And essentially, the challenge that you are facing is that subsequent surgeries still
resulted in the implants looking too large and not looking right for your face.
So now that you don't have these implants, you want to know, can you have fillers or
is the scar tissue going to be problematic.
Well, I can certainly provide you with some guidance in the absence of a photo from my
experience with comparable situations 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.
I perform facial implants fairly routinely as well as provide non-surgical solutions
such as something called Structural Volumizing that provides comparable results and I think
that I can give you some understanding of what your options can be.
So to begin with, yes, there is certainly a known issue with any type of facial implant
particularly in the midface, the cheek area, as one gets older.
It’s become more clearly well-defined in the medical literature that facial aging is
particularly characterized by a change in bone structure volume.
And bone loss is important as part of the foundation in what the facial overlying can
look like.
So when you appreciate that not only is the bone loss significant but the soft tissue
gets thinner as we get older that means the skin, the fat, the muscle.
Understanding all that, it is certainly understandable how you went through this path.
Now as far as the considerations of scar tissue are concerned, certainly it is something that,
as any doctor doing this would be concerned about and I would have to say that there is,
in my perspective, speaking as a surgeon, there is a certain advantage to a surgeon
who does this type of surgery to understand the planes that are involved when you are
placing a filler understanding that there is previous surgery.
When we do a procedure called Structural Volumizing, we actually place the filler at a level that
is comparable to the level that the cheek implant was placed.
And so it’s placed at the bone level between the bone and the muscle.
And in that way, the filler fills the void or the deficit that is necessary to create
projection and give the person nice looking cheeks.
That being said, although this is a technical aspect that may be relevant and still doesn't
mean that there hasn't been any changes anatomically from repeat surgeries, there is a layer over
the bone called the periosteum.
It is a very tight sheet that is connected over the bone.
When you place a facial implant, the periosteum is lifted away and the implant is placed on
the bone and then the periosteum is redraped.
When you are placing filler, you are not going below at that same level.
So that could be the space which has the majority of the scar tissue.
And conceptually, it’s possible that the tissue above the periosteum may be relatively,
have limited impact from the previous surgery.
Now that doesn't mean that the surgeon previously may have, as part of the procedure, crossed
those boundaries as just part of the course and process of doing surgery.
But I think that, I would say in my hands when I treat someone who has similar history,
I can usually tell using the methods of using these blunt instruments called blunt cannulas
at the level between the muscle and the bone, then I could probably, with reasonable certainty
get a result that respects those tissue planes in a way that gets a good result.
I think that it’s something that you have to figure out by doing.
And certainly, there are certain precautions that would probably be advisable when you
have a consultation with the doctor.
So learn more about Structural Volumizing and about this technique and I think that
there is hope for you to be able to achieve a look that’s comparable to having a facial
implant but still be more customized and that’s a point that I should also make.
The very nice thing about fillers is that you can really customize the volume, the placement,
the level.
So you can really mold it in a way like a sculptor so that you can get a nice result
that fits your face at various levels so that you can get a nice natural look that can be
pleasing and look right for you.
So that’s an additional benefit of using fillers.
So I hope that was helpful, I wish you the best of luck and thank you for your question.