For patients at Omaha, NE dermatologist Joel Schlessinger, MD’s practice one common aging concern hits that of the standard “sagging skin” complaint.
“It used to be that a facelift was the usual way of remedying this, but the look of this wasn’t ever natural or truly pleasing when aiming just to correct the cheeks, and it looked ‘stretched’ or ‘done,’” he says, adding that, for him, fillers are the solution of choice, but warns they have to be done carefully and with skill and sensitivity.
“It isn’t just as simple as having enough filler and a person at the other end of the syringe injecting…that’s quite obvious in the many pictures you see of people who have too much done and then look terrible. It is about having a person who strategically places filler in the right areas and then knows when to stop!”
Plus, Dr. Schlessinger adds, there are now many new fillers available, as well as older ones that remain incredibly effective and useful. “But—and I can’t stress enough!—it’s not about the filler or the amount of filler used, it’s about the artistry and sensibility of the injector who is injecting it.”
Short Hills, NJ facial plastic surgeon Alexander Ovchinsky, MD also stresses the skill factor and agrees that the most common choice today for cheek or midfacial augmentation are fillers.
“My preference for this area is to use thicker, more viscous fillers to achieve better volumization and longer-lasting results. Fat transfer can also provide great and long-lasting results in this particular area. However, it does require a secondary procedure to harvest the fat.”
While Dr. Ovchinsky says there’s not much that can be done topically to improve volume in the cheeks, there are a few noninvasive options to improve something directly linked to sagging: skin laxity. “These are usually energy-based options such as ultrasound energy and radiofrequency energy. A few skin-care modalities, such as microneedling, which can be used in combination with radiofrequency and a non-ablative laser may also help improving skin firmness and tightness.”
As Newport Beach, CA plastic surgeon Sanjay Grover, MD says, not only is midface aging—aka, cheek deflation or descent—one of the tell-tale signs of aging, but, like most facial factors, it can create a sort of cause-and-effect.
“Deflation in this area not only gives one an aged appearance, it also contributes to aging of the lower eyelids and nasolabial folds, otherwise known as smile lines,” he says, adding that midface rejuvenation can be addressed both surgically and nonsurgically. Nonsurgical or minimally invasive options include fillers such as HA products or hydoxylappatite products, biostimulants such as Sculptra, a patient’s own fat, thermal devices such as Ultherapy or Profound RF, or even threads.”
Plus, he adds, there are a variety of ways injectables and fillers can be delivered. “Some injectors may prefer a needle, a microcannula or a combination of both, and these treatments are relatively quick with little discomfort. Topical options to slow down the aging process includes a retinol, as well as a hyaluronic acid product to replenish volume and rehydrate.”
For Scottsdale, AZ facial plastic surgeon Kelly V. Bomer, MD hyaluronic acid fillers are the mode of choice when treating sagging cheeks and says it has “very rewarding results.”
“It is a common concern that happens with aging—and it can make the eyes look hollower, increase the depth of the nasolabial folds and add to jowl formation. I feel cheek augmentation is the most predictable utilizing hyaluronic fillers as opposed to silicone implants or fat transfer.”
Dr. Bomers instructs that, for optimal results, it is best to address bony highlights and contours separate from fat pad curves. “Cheeks are unique to varied facial shapes and with proper injection the filler moves well with animation and provides support to the overlying skin to reduce wrinkles and folding.”
And it doesn’t stop there: “Cheek wrinkles and fine lines can optimally be improved with adoption of medical-grade skin care, in addition to filler, and should including a strong retinol and glycolic acid as well as peptides and moisturizer,” she says. “The skin must be treated for aging continuously without significant time off for success because the skin is always renewing itself. Skin treatments like chemical peels, IPL and microneedling (without radiofrequency) are great partners with home skincare for maximal skin rejuvenation to improve cheek highlights with good reflectivity, smoothing of lines with collagen building and elasticity repair and skin pumping by increasing moisture content.”