Thank you for your question.
You submitted a question without a photo and you’re asking in your question whether use
of saline is a good way to predict how a cheek implant will look.
And you stated that you understand that fillers are an alternative but you want to avoid bruising
and you’re looking for something more permanent.
Well, I can certainly help you with this type of question.
We deal with this question pretty much every day in our 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 I have, throughout my career, used different solutions to help augment the cheeks both
surgically and non-surgically, everything from cheek implants, fat grafting and injecting
fillers.
So I will share with you a little bit of perspective and perhaps help you take a longer view as
to what permanence is.
So to begin with and just talking about the facial implant solution, certainly cheek implants
work and they can be very effective in providing really good volume in the face and have a
nice outcome.
In terms of trying to use a tool for predictability, I think that saline has limited value and
I’ll explain why and this is from, again, firsthand experience.
We would often try just putting a little bit of saline to try to create what the volume
can be but the problem is that the saline dissipates very quickly and it creates more
global filling.
It ends up filling the soft tissue as well as the area that we would place the cheek
implant.
So I would say that saline as a predictor is not 100% percent useless but it’s not
really as useful for predictability as would be ideal.
I think that it’s very important to understand that when we talk about a permanent implant
in the face, we’re still having to accept that the face does change with time and that
change involves bone loss.
It involves loss of fat and loss of soft tissue and skin quality and thickness.
So you can certainly want something that’s long-term but understand that there can be,
depending on facial anatomy, a change that can be not so great with time when it comes
to permanent facial implants.
Now again, I still strongly believe in the benefits but when I look at my patients these
days and again, having gone through the evolution of cheek implants, fat grafting and fillers
and as a surgeon, I have all the tools in front of me to be able to do these things,
I’m not limited.
As far as that concern about bruising and longevity, I think that you can at least maybe
investigate this concept called structural volumizing and I’ll explain further.
Before there were long lasting fillers, we had a lot of limitations.
But once longer lasting fillers such as Juvederm Ultra Plus and Juvederm Voluma came along,
now we have a hyaluronic acid filler that can last considerably longer and it can last
in terms of more than 1 year up to 2 years.
Now that’s still not permanent but think of it this way, when we do structural volumizing,
we’re placing the filler at the bone level, literally going where the most contribution
to loss of volume is related to facial aging.
And what I find really wonderful about doing this is that I can place the filler at different
areas in a way that I can really customize and sculpt the appearance in way to create
a nice natural look and create the augmentation that I want.
In surgery, it’s difficult to do that same thing.
In surgery, we’re injecting local anesthetic into the tissue space and we’re releasing
all of these connections and then placing the implants accordingly.
Yes, we can try to massage out the fluid and look at the projection of the implants and
the overall shape and try to maximize symmetry.
It’s not completely out of the question but we are dealing with a certain amount of
swelling that we can’t just always compensate for and you can shape implants so you can
certainly do that.
But now we have these fillers, I find myself routinely using these fillers considerably
more often than I would ever do cheek implants.
And a lot of people have objections to the concept of facial implants and so certainly,
they’re not going to consider that anyway.
But if you’re open to the idea, you may want to think about using structural volumizing.
And you mentioned that you are concerned about bruising.
When we do these procedures, the technique basically is 99.9% without bruising and it
really works out very well.
This is a unique approach and most physicians don’t perform this procedure regardless
of specialty.
It’s just a certain learned technique that has worked very effectively in our practice.
And so when I talk about solutions for a particular, let’s say, age range of mid 30s to all the
way into the 60s, you actually have a lot of volumetric loss and opportunity to create
volume and do it in a way that’s customizable, that is predictable, it’s very safe and
extremely convenient.
So what I can do in literally minutes with filler that would take me more than an hour
or actually minutes per side, but in surgery, under anesthesia so you think about just the
total time and the healing process, it really is no comparison.
Now cheek implants do have a role but in my practice, it’s basically become a role that
is relevant during patient’s whom I’m going to do face lifting.
If someone needs facial volume and is not interested in fillers, well I can offer them
the placement of cheek implants at the time of face lifting to help them with that area
of concern.
But again, by in large, we’ve been able to help a lot more people with structural
volumizing because of all of the benefits that I described earlier.
So I think you get the best of both worlds by that technique.
You get the long-term benefit, not permanent, but long-term.
At the same time, you avoid the bruisability, you avoid surgery and you are able to get
a very nice outcome that you can have performed at a certain degree of convenience.
A lot of times people who have these types of procedures like cheek implants are still
going to do Botox® injection, are still going to do other fillers, are still going to do
other laser procedures.
So it’s not like they’re not visiting the doctor’s office for other enhancement
type of procedures.
So it makes sense for someone like that to consider structural volumizing as an alternative
to cheek implants.
So I hope that was helpful, I wish you the best of luck and thank you for your question.