Thank you for your question.
You submitted several photos and you’re asking about the possibility of getting Voluma
in your cheeks or Juvederm Ultra Plus into your nasolabial folds as well as possibly
getting enhancement in the chin area.
Well, certainly I can share with you my approach to patients who ask similar questions 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 and helping people
with facial aging is a very significant part of my practice and I would say that, not just
facial aging but often it’s more about the genetics of facial volume.
And so, you’ve certainly done your research and you’ve learned about the specific indications
for these different fillers.
Now, to give you a little bit of guidance as to the approach and this is what differentiates
different doctors in how they do things and everyone does things in their own way but
understandably, there is some degree of perception and confusion about what the best solutions
are for these different anatomic areas.
So I’ll tell you a little bit about what I do when I see patients at consultation.
I begin by taking photos.
And I take photos at the front view, three quarters, side views for both sides and I
place these photos up on the screen.
And I help people understand where there are things that look like opportunities to improve
in a more global sense and certainly, I listen very intently to the priorities of the patient.
Now, you are familiar with Juvederm Voluma.
We’ll start with that filler and yes, it has a very important role in different ways
in the spectrum of options but one of the things that I would caution you about any
filler when you talk about the volume in the cheek area as well as in the nasolabial fold
is you need to place the filler at the right level.
Now what does that mean?
It is very common for patients to come in and discuss these concerns with me and then
when I talk to them about different fillers, literally without any exceptions, patients
will always say “I don’t want to look like a chipmunk.
I don’t want to look like I’m all puffed out.”
And that’s because they see way too many people that do look like chipmunks and they
see way too many well-known people who look very swollen and very pillowy.
So now you wonder why is that an issue.
A lot of times, before explaining that, I would say that patients have also come who
have gotten these fillers and they were either under corrected where they just got a little
bit and they feel like they got nothing or they got too much and they were unhappy with
the results.
And I think the basic issue is in the technique and placement.
And there is an anatomic concept that takes a little bit of time to understand but I’ll
explain how I explain to my patients.
When you look at your cheekbone area, there are essentially compartments that have to
do with the volume loss, genetic volume deficiency and potential space.
And what we’re not doing is necessarily an augmentation but rather, we’re making
a correction to help restore facial harmony and balance.
This way, you avoid that puffy look.
Now how do we get that nice youthful angularity?
This is something that I really take issue with because a lot of my colleagues who believe
that youthful appearance means smooth skin only often overfill the face and they end
up looking more rounded.
Well, there’s a concept called structural volumizing.
And structural volumizing is placement of these fillers particularly in our practice,
we use long lasting fillers such as Juvederm Ultra Plus and Juvederm Voluma and we place
it at the bone structure level so literally below that soft tissue where people can get
more rounded but at the level of the bone where you actually can be much more defined.
By placing at that level, the cheekbones look more nice and angular and natural.
And the skin actually glides over the cheekbone and doesn’t have the physical weight when
the cheek becomes filled.
A lot of times, when people have a volume deficiency, a very well-meaning doctor will
place this material in the soft tissue space and will create volume and it may look good
on the chair but afterwards, as the person talks and smiles, that material gets softer
and just kind of spreads out a little bit and then they look kind of strange and pillowy.
So I think there’s an opportunity in your situation to restore volume in the cheekbone.
Yes, you can soften the nasolabial fold but I’ll tell you that, in my experience, a
lot of times, once I restore cheek volume, the nasolabial fold gets less important and
less significant because it’s a balance.
If you look at younger people, a lot of young people have significant nasolabial folds but
they also have a balance.
They have volume.
So there’s something called the golden ratio where the upper part of the face is slightly
wider than the lower part of the face.
It’s a 1.6:1 ratio.
So when you create that, there’s this natural perception of facial harmony.
Now speaking about facial harmony, to address the issue of the chin, it is very interesting
how a little bit of projection of the chin which we’ve always done traditionally with
chin implants, we can now do with thicker fillers such as Juvederm Ultra Plus and Juvederm
Voluma.
You can get also some balance both from the front view of the length of the face to proportionally
balance the upper third, middle third and lower third as well as in the profile view.
And that together can look very good.
And again, it goes back to structural volumizing, putting the material at the level where I
think makes the most impact.
One of the things about maturing is that there is significant bone loss and that little bit
of bone loss can result in a lot of volume loss.
And so, placing it at the right place really makes a difference.
And from that perspective, I have to always emphasize, the fillers with the names that
you know are really just tools that a skilled practitioner can apply to give an optimal
outcome and that communication between you and the practitioner and the methods employed
are what ultimately creates the best result.
So meet with some doctors and get some opinions and learn about structural volumizing and
I think you’ll find that, even if you take small steps, you’ll find that this will
be a very good strategy for you and I think you won’t necessarily have to be specifically
focused on the products but rather the technique and the end result.
So I hope that was helpful, I wish you the best of luck and thank you for your question.