There have been several advancements in cheek augmentation products in recent years as well as changes in the procedure goals itself. To understand these progressions, we should understand the mid-face area. The mid-face is defined as the area under the eyes and above the mouth and includes all bony as well as soft-tissue compartments within that space. There are several fat components in this area that are either superficial or deep to the skin. These deep fat compartments are a major determining factor in the overall outer structure and appearance of the face. Aging in this area usually results in the cheeks falling closer to the mouth and nose. As a result, a patient’s smile lines become deeper and more permanent, and the transition between the mid-face and lower face is more noticeable.

Patients may also notice the outer aspects of their face have lost volume and contour. This process involves the several factors. First, with age, the fat compartments in the mid-face atrophy or become smaller. Since these areas are a major determinant in facial topography, the loss of fat in these compartments produces a “falling” face. Patients often notice that their cheeks have dropped around their mouth. In addition, the cheekbone is thinner and more noticeable as result of the atrophy of the overlying fat compartments. Second, the composition of the skin changes with age as the water content in skin increases in relation to collagen and hyaluronic acid. This leads to a decrease in skin turgor.

Therefore, subtle enhancements in the mid-face can make substantial improvements in a patient’s appearance not only in the mid-face but also in the lower face, especially around the mouth.

In the past, the focus of increasing cheek volume has been focused on addressing the size of the inner or medial aspect of the cheeks. This is defined as the area just below the eyes. Patients would often have “ apple” shaped cheeks, which would look more youthful. However, patients have complained that this would affect the appearance of their eyes as well as their smile lines.

More recent techniques, however, focus on addressing the outer or lateral cheek. This is the area just below and to the outer edge of the eye. Injections of this area are performed to add volume to these compartments. The results produce a lifting effect to the face. The cheeks, which typically drop with age, are repositioned back to their anatomical location. In addition, patients often notice that their face appears fuller and the depth of their smile lines have significantly improved. The face also has an improved 3-dimensional contour especially when examining a person from a 45-degree angle. Patients often come to the office in the hopes of eradicating their smile lines; however, with careful facial examination and consultation, addressing the mid-face would create substantial improvement in their appearance.

The highest recommended dermal filler for the mid-face is Juvederm Voluma, and it is the only FDA approved dermal filler for cheek augmentation. This product lasts up to two years in duration and has state of the art hyaluronic acid cross linking, resulting a thicker material that is able to lift the mid-face and counteract the effects of gravity on the face.

Interested in learning more? Please contact us at 925 989 6560 to schedule a consultation.

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