Thank you for your question.
You state in your question and you submit a photo and you blocked out your eyes but
in this question, you are essentially describing a situation where you feel like your entire
life, you've had sagging cheeks and that you had deepening, as you got older, of the
nasolabial folds and worsening of the under eye bags which we can't see with the blocking
off.
And you are asking about some way to lift the area of the cheeks and to improve the
overall appearance.
And you also mentioned about some stuff like acne scarring as well.
But let me just first focus on the global issues and again you state that you are 28-years-old.
Well, I can certainly help you with understanding what is probably contributing to this perception.
A little bit of background, I'm a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I've been in practice in Manhattan and Long Island for over 20 years and I have performed
a full range of procedures including minimally invasive to all the way to advanced surgical
procedures and so I can give you an understanding of really how I would interpret what you are
describing.
So to begin with, at 28 you are still very young.
And so in terms of what you have dealt with throughout your life is really more about
anatomy and not so much about age-related changes.
Yes, you can have the perception that your cheeks are sagging but I believe what is also
an equally relevant way to look at this and probably more appropriate for you is that
the cheek is not just well-defined.
There is a difference between how we treat people with facial aging.
With facial aging, it is about restoring.
It is about volume loss and about sagging.
When you speak about younger people, it is really often about subtle but natural enhancement
to beautify and to create balance.
So I would suggest in someone like yourself, I would want to do the least amount possible
to try to get the best outcome.
So I would say that without looking at the under eye bags area, which is a topic that
I'll be discussing momentarily, in terms of the cheek and nasolabial folds aspect,
I think it is worth considering a procedure that we refer to as structural volumizing.
Structural volumizing is the application of traditional fillers such as Juvederm Ultra
Plus, Juvederm Voluma but placement that is different than traditional fillers.
Traditional fillers are typically placed in the cheeks and right under the skin whether
it is in the nasolabial folds or the cheeks.
In structural volumizing, we are placing it between the bone and the muscle and what's
the point of that?
Well, there is something called the Golden Ratio and the Golden Ratio in facial harmony
and facial balance is the ratio of a width of 1.6 to 1 where the upper part of the face
is slightly wider than the lower part.
Interestingly, it can make a person look thinner and that is because of the Golden Ratio which
is something that has been around for a long time since the ancient times.
So with this structural volumizing in the cheekbone area, accentuating the cheekbones
can actually really enhance the overall appearance of the face.
What I like about considering a hyaluronic acid filler such as the fillers that I mentioned
is that in the worst case scenario, you can actually dissolve these fillers and you can
start from scratch.
So the reversibility of this type of approach makes it very appealing.
Now if you have been having under eye bags for most of your life, then there is a very
good chance you are dealing with something called lower eyelid fat prolapse.
And lower eyelid fat prolapse means that the fat pockets that are normally around the eyes
push forward and create a bulge.
Now, I'm not getting ahead of ourselves and say that you are a good candidate for
one procedure or another but the options for under eye bags in my practice is based on
the relative prominence of the under eye bags.
If they are relatively subtle and can be blended then we use an injectable filler like Restylane
to fill the area of the tear trough to create a better transition between the under eye
bags and the adjacent area.
We also use something called platelet-rich plasma (PRP) derived from your own blood but
that is a different story if you don't have that much wrinkling or discoloration under
the eyes.
If the under eye bag is much more prominent and it is not amenable or appropriate to treat
this area because you might create too much volume then the option for that is a procedure
called lower eyelid blepharoplasty and typically a transconjunctival blepharoplasty.
So, I think you want to take or I would recommend that you take little steps.
You are still very young and I tend to be, this is a personal style, I tend to be very
conservative.
I always tell younger people that once you get into your 40s and over, there will be
plenty of opportunities to do things because facial aging changes will manifest more significantly.
But prior to that, little things can go a long way whether it is cheek augmentation,
lip augmentation.
Little things can actually make a nice difference for people who genetically do not have the
volume on those areas that they desire.
So, learn about these options.
Find a doctor that you are comfortable with.
You really need to feel comfortable with the doctor's style, their aesthetic and learn
about what you like to be, what you like to try.
Very often, when we discuss these issues with patients, we come up with a priority list
and then we figure out what's the highest priority and try to go to what has the most
significant impact, cost the least amount and will likely be satisfactory.
So, learn about these different options.
You may need to visit a few different doctors and then find what you are comfortable with
and move forward and take your first step.
So I hope that was helpful, I wish you the best of luck and thank you for your question.
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