As I perform more and more facial fillers to restore youthful cheeks, I continue to be excited about the wonderful changes we see with only one or two cc’s of filler. Most patients who are candidates either ask about treating nasolabial lines and folds (they run from the corner of the nose to the mouth). However if you look more closely at their cheeks, as people age beyond the mid 30’s we lose the baby fat that gave us youthful fullness. Remember those cheeks that your aunts and grandmother used to pinch?
Now, when I look closely at these cheeks, I often see a mound (cheekbones), hollowness beneath, then a nasolabial “mound” then the nasolabial fold. Filling just the nasolabial fold doesn’t go very far in making patients appear more youthful. What I prefer, and most patients agree, is to first restore volume to the cheeks. I use filler to restore volume under the cheekbones. Then I need only a little filler in the actual nasolabial fold since the volume restoration lifts the nasolabial folds up and out. On “beginners” we often start with only 1 cc (syringe) of filler. For more volume, 1 per side is sufficient. To enhance cheekbones, the filler can be tailored to each patients’ needs by highlighting, restoring or creating beautiful cheekbones as well.
What filler do I like to use? On a first-timer, I usually start with Juvederm Ultra. This is the smoothest, most mold-able filler and it gives the most subtle enhancement. I sometimes use Restylane as well but find that Juvederm is more mold-able. These fillers typically last from 6 to 9 months in the cheeks. For more volume and a longer lasting effect the next choice is Juvederm Ultra Plusor Perlane (basically, this is thick Restylane). These fillers provide more volume. Plus they often last from 9 months to a year. Want even longer lasting effects, especially for building high cheekbones? I will address this in a future blog. It is what I call Runway Cheeks. The next choice following hyaluronic acid fillers (Juvederm, Restylane and Perlane), I use Radiesse, for a 1 year plus result.
When patients have very hollow cheeks and require a large volume replacement. My first choice is Scuptra. Using one’s own fat for fat transfer is also an option.
So for beautiful, youthful cheeks there are many options. The best option is to come in or visit your favorite facial plastic surgeon for personalized recommendations. By the way, the same choices and process applies to melolabial folds or marionette lines that run from the corners of the mouth downward.