For those who do not want surgery to improve their look, there are options. The photograph illustrates the power of in the office injectables to build out the cheek and jaw line. NO SURGERY was performed. While there are many choices when it comes to facial reshaping with volume, I believe each product has its own place.
Autologous fat grafting is generally my procedure of choice for those with a sunken in or long face who desire surgery and don’t mind over a week of swelling. With fat grafting, fat is taken from an unwanted area like the hips and flanks (liposuction is also often performed to reduce fat deposits and sculpt the body), and injected into the face to restore the volume loss with aging. Remember, aging is more than wrinkles and saggy skin. Even if we remove wrinkles and pull skin, we don’t adequately address the true enemy of aging: shadows. I consider injectables an art, because in a sense we are “photo shopping” shadows, to use a computer analogy. The shadows generated from aging are pretty predictable, but even shadow filling doesn’t complete the facial balancing picture. The other component to reshaping is architecture. Facial architecture refers to the prominences of the face such as the cheek bone, jaw, and chin relationships. For example, older faces become bottom heavy, and thus part of the plan to restore youth includes building out the upper third of the face (temples and cheek bone area).
But the above gentleman isn’t old. He’s rather young and in very good physical shape. Such good shape that there isn’t much fat to take even if I wanted to harvest it for fat grafting. So, the perfect choice for a young man who doesn’t want down time is injectables. There are many choices of filling products such as Juvederm, Restylane, Perlane, and Radiesse.
Radiesse is calcium hydroxylapatite, the natural component of both and teeth. For architecture, this is my product of choice. It tends to last the longest (over 1.5 years) and in some cases the product allows integration of tissues to generate permanent results. Radiesse was injected along the jaw line, building it out, and the cheek bones. These 4 prominences (cheek bone to cheek bone and jaw prominence to jaw prominence) generally look best when they form a square on front view. Shadows generated from low body fat (which is very common in men in good shape) can be filled with Juvederm or Radiesse. I tend to use Radiesse for deep filling in this region for the properties of the product already mentioned. Folds (laugh lines) were filled just where the fold meets the nose. Filling too far down the fold imparts an artificial look. Temples are unfortunately often ignored by plastic surgeons. The temples to me are a continuation of the cheek bone. Cheek bone injections or implants tend to look “done” or fake when the temples are not blended into the addition. Thus, with any major cheekbone build-out, I think it is imperative to fill the temples, particularly in long face individuals.
Thus, significant, natural results can be achieved even with large volume injections. And men and women who don’t want to have surgery or down time can get a look-boost in the office. However, one must understand the anatomy, facial unit relationships, and aging patterns to create natural-looking remodeling.