Cheek Augmentation

Do you find your cheeks looking flat of low cheekbones? Or perhaps you used to have full apples of your cheeks but it seems to have deflated over the years due to aging. As we age, we lose volume in the superficial malar fat pad, which leads to hollowing of the cheeks, a gaunt look, the appearance of sunken undereyes and prominent nasolabial folds due to excess lax skin. In fact, many Asians lose the medial cheek volume as the first sign of aging but it is not apparent to most until more advanced aging has taken place. Do not wait until it is too late!

You can reverse the problem with cheek filler correction. Only 2-3 injections are required per cheek to place filler into the malar area of the cheeks, refilling and plumping it up for youthful fullness. This procedure takes about 30 minutes, with minimal downtime if at all. Hyaluronic acid or Radiesse are two of the best choices of filler for this purpose. They give instant gratification by taking years off your face immediately.

The advantages of cheek filler has not been expounded sufficiently. Cheeks are only small areas on the face but simple filler correction of volume loss on the cheeks not only improve the cheeks immediately for a more youthful appearance– it also lifts and improves jowling & nasolabial folds (laugh lines) and reduce the appearance of eye bags and undereye bulges. It is a myth that cheek filler makes one look like one has put on weight. As long as the filler is not overdone, the effect can be very natural and aesthetically pleasing.

What are the possible side effects

There are very few uncommon side effects with cheek filler augmentation. There may be some swelling for a few days, after which the filler in the cheek may reduce 20% when the swelling subsides. Bruising seldom occurs on the cheeks. Pain is minimal as the filler usually contains anesthetic.

How many types of fillers are there?

In a nutshell, fillers can be classified into temporary, semi-permanent and permanent fillers. Our favourite is the hyaluronic acid (HA), which is a temporary filler lasting between 9-12 months. It’s made of glycosaminoglycan polysaccharide and is not just found to be naturally occurring in the body as universal extracellular matrix– it’s also chemically identical across species and therefore, is very low on antigenicity, i.e. less likely to cause bad immune reactions. In other words, it’s very safe. Two well known brands are Juvederm and Restylane. There are many other brands in the market that are also similarly good in quality. Be sure to check with your doctor on this.

There is also the semi-permanent fillers such as Sculptra and Radiesse. Sculptra consists of poly-L-lactic acid and Radiesse contains calcium hydroxyapatite. Both of them essentially work by having an initial bulking effect plus an additional benefit of stimulating collagen synthesis wherever they are placed. This prolongs their volume enhancing effect in the mid-term and they may therefore be able to last slightly longer. An alternative would be to choose a more viscous HA product, such as Juvederm Voluma.

Permanent fillers last the longest. Examples include Aquamid, which is a polyacrylamide gel (i.e. plastic), and liquid silicone, which is the longest lasting of all FDA approved fillers. These can last for years. However, the longer lasting the filler, the more likely it can cause complications such as lumps and scarring.

Why did the facial filler seem to decrease so quickly in the first 2 days after injection?

Hyaluronic acid (HA) occurs naturally without cross linkages. In this form, it is easily broken down in the body in 1-2 days. The HA that remains are those that are still cross-linked, which prevents its breakdown, and this is the form that lasts. Therefore, your facial filler with HA can seem to decrease quickly in the first 2 days before it plateaus into a steady state. The rest decreases slowly. Therefore, the more cross-linked the HA, the longer it lasts.

Should I always choose the brand of HA that lasts the longest to save cost?

The longer HA lasts, the more viscous it must be and therefore, the harder its feel will be. Harder HA may not be suitable for all areas of facial correction, even though they last longer, because they may not be suitable for all areas or feel all that natural in others.

Why does my nose have a bluish tinge after filler injection with hyaluronic acid?

If it isn’t a bruise, it can be due to the Tyndall effect, which occurs after injection of hyaluronic acid is done too superficially so that it shows through the skin, making it take on a bluish tint that is not easily hidden by makeup. It doesn’t happen often, though, and can be avoided by placing the filler in the correct plane. Newer improved fillers seldom give the Tyndall effect these days.

After a facial filler injection, can I go for massage or wash my face?

Temporary fillers are moldable in the first 4 hours or so and they set in approximately 2 days. In the first 4 hours, you shouldn’t apply firm pressure on the area of the filler or massage too hard. Gentle washing of the face is permitted. For the first 2 days, it is advisable not to apply prolonged pressure on the area of the facial filler e.g. sleeping on that side of the face– there is a slight chance it may shift. Thereafter, once it has set, you can do whatever you want and it should not change in shape.

Myths about dermal fillers– busted.

Myth: Fillers are permanent.

Truth: There are many different types of fillers. Some are permanent, some are semi-permanent and the rest are temporary fillers. Temporary fillers are mostly made of hyaluronic acid nowadays. It is a substance that is also naturally found in the body and is absolutely safe for use. It is gradually broken down by the body and absorbed, usually lasting from 6-12 months.

Myth: Fillers are harmful for the body since they are absorbed by the body.

Truth: Absolutely not. Hyaluronic acid, which is used as temporary filler, is a natural substance found in the skin, joints and eyes of the body. It is gradually broken down by the body and not harmful to health. In fact, brands of fillers such as Juvederm has obtained FDA’s approval for clinical use– it is also one of the most common facial fillers used in my clinic.

Myth: Surgery is required to place fillers into the body.

Truth: Not at all. Facial fillers for the nose, nasolabial folds, cheeks, chin, etc. are easily placed into the respective parts via a few simple injections. There is no need to undergo the knife– hence the wonder of minimally invasive procedures. Even breast fillers only require 1 or 2 injection sites under the breasts. Minimal pain and minimal scarring, in just under 15min!

Myth: You need to keep coming back for frequent top-ups once you do fillers.

Truth: Top-ups are required only because temporary fillers are naturally broken down by the body and absorbed, so its effect diminishes over time. They are not in the least bit addictive and you can choose not to top up again if you’d like. The filler will simply disappear and the part of the body will return to its original state as before filler was done.

Myth: When the filler disappears, you’ll look worse than before.

Truth: Fillers do not change the original state of the body part it is placed into. When it is absorbed, that part of the body simply returns to how it was supposed to be. Of course, temporary fillers last up to a year or more and in that time, the body is still undergoing its own aging process.

Myth: Fillers are harmful to the body when used in the long term.

Truth: Hyaluronic acid is a natural substance found in the skin, eyes and joints. It is gradually broken down by the body’s natural metabolism and is not known to be harmful in the long term or short term.

Myth: Fillers change the shape of the body part permanently.

Truth: Not all fillers. Temporary fillers are made up of hyaluronic acid which are absorbed by the body over months and gradually, the body returns to its original state, as it was before. Of course, as part of aging and change, the body does sometimes alter from its natural state but it is not usually affected by temporary fillers like these. Permanent fillers are not absorbed, though, and they can stay for a long long time. In that sense, they change the shape of the body part permanently.

Myth: Doing something to your face with fillers makes it look fake.

Truth: Amazingly, it is rather difficult to look fake with facial fillers. They can give dramatic results but they usually can escape others’ eyes unnoticed. Too many have told me how they wished people had noticed– even though in their own eyes, it was a great difference!

Myth: Fillers are very painful.

Truth: Some pain is to be expected but it is usually minimal and quickly forgotten after the procedure. The pain is usually only of the injections and subsequently, a vague dull ache during filler injection. After the procedure, the dull ache may remain for a couple of days but it isn’t particularly noticeable and resolves quickly. In other words, it definitely isn’t something you’ll remember for too long.

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