Thank you for your question.
You submitted your question with several photos.
And you're asking, should you get a malar, submalar or combined implant.
And you're stating in the details of your question that you want something permanent
and you don't want fillers.
And you stated that as your face has been aging, that the nose is looking more prominent.
And you're describing that your goal is to have a more youthful, more rounder look
and not so chiseled but it has to look natural with your thin face.
Well, I can certainly share with you some basic concepts of how a surgeon determines
what kind of implant is appropriate for a patient as well as some perspective that I
think is important that maybe has not been fully discussed with you at this point.
A little bit of background, I'm a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Helping patients like yourself with facial aging changes through different surgical and
non-surgical approaches has been the core of my career for the past 20 years.
And certainly, I can share with you a little bit of the evolution of my thinking and really
what has become more of an approach that I think will be relevant to your situation.
So part of the challenge is that you are dealing with results of facial aging which is progressive
yet you want something permanent.
And understanding that facial aging from a global perspective, what you're mostly experiencing
at this point has to do with a relative diminishing of bone volume.
So of course, it stands to reason that placement of an implant will make sense.
So to distinguish the difference between a malar, submalar and a combined implant, well
the malar implant is basically aiming towards increasing the projection of the cheekbone
prominence or the area called the malar eminence.
The submalar implant is to fill that area below the cheek called the submalar area.
And when you combine the two, you get an implant that does both.
Now the challenge in your situation is how can an implant be placed that will not look
so chiseled and rounded and look harmonious with your face.
I think that from a surgeon's perspective, there is a leaning to do something more conservative
because for a person with a thin face, you're going to avoid that disproportionality which
can appear to look chiseled, the surgeon will lean towards placing a smaller sized implant
regardless of whether it's a submalar or combined implant.
If you were to do only a malar implant, I think that you would probably just feel like
the chiseled look would be accentuating the thinness of your face.
Now dealing with this type of challenge has become different in my practice based in the
introduction of several things.
One is the use of long lasting fillers such as Juvederm Ultra Plus and Juvederm Voluma
and a technique called Structural Volumizing.
Now Structural Volumizing allows me with my surgical background and surgical knowledge
to make corrections of these areas of deficit in a person's face not only in the cheek
area but in other areas of the face such as the chin and the jaw angle.
If you want to get a more softer look overall, then I recognize the resistance of wanting
to do fillers with some regularity.
Patients frequently ask about doing something permanent but recognizing that aging changes
is not only bone loss but muscle, fat, soft tissue and that the skin gets thinner with
time, then there's a challenge with putting an implant when the soft tissue overlying
that implant is going to continue to thin and this is an issue that of course is discussed
before doing an implant placement.
With Structural Volumizing, I've been able to place these long lasting fillers in a way
that I'm able to control so I can compensate for asymmetries and I can also place in multiple
areas.
A lot of times when I show a patient of before and after of a Structural Volumizing patient,
I further explain that to get a similar result, I would have to place a cheek implant, a chin
implant and a jaw angle implant which is considerably a lot more surgery.
Further, because I am able to further control the amount and volume of placement, it really
makes this an ideal.
And I can certainly tell you that more people are more comfortable with the placement of
long lasting fillers than doing a surgery and taking the risk that they'll still need
filler afterwards.
This is an important point.
When you have a facial implant, it only addresses a limited area, though it is an important
area that will help you look better but when you look at your face, you want to look at
the balance, the harmony that is very important to look youthful and there are many elements
to that.
So I think it is important, as you do your consultations, you get a realistic understanding
of what the outcome will be.
The last thing you want is to go into the surgery with this expectation that this will
be the definitive procedure that will bring harmony to your face and then have to still
do fillers so it's important and I tell this to my patients who I also do facelifts
for.
When patients come and say "I want to get a facelift so I can look young for a long
time", I say that a facelift will help you restore the position of the cheek and improve
the jawline and the neck but it doesn't negate the need or displace the need for fillers.
Understanding that facial aging is volume loss and descent, you want to address all
those elements to get balance and harmony.
So it has become my practice even though I am a surgeon and I love doing surgery, to
guide my patients based on the tools and the outcomes that I can achieve that I feel are
exceptional using Structural Volumizing in the course of what is no more than 30 mins
that essentially has replaced what I used to do with surgery.
Now it's not the case for every patient.
There are certainly a lot of people who we see in our practice choose that option.
And the fact that these fillers can last for 2 years makes it fairly easy to do.
Now a lot of times people need fillers in other areas.
Facial aging is not limited to the area that bothers you.
People want volume in their lips, they want volume in the more superficial lines and other
areas.
So we really have a wide range of fillers and different techniques to deliver those
fillers to get a look that is customizable in real time and I think that's important
to consider as you're making your decision and strategizing in dealing with your facial
aging changes.
So I hope that was helpful, I wish you the best of luck and thank you for your question.
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