24 February 2021
Cheek fillers- Rejuvenation and augmentation of the cheek using dermal fillers can enhance and refresh the appearance of a patient immediately. The lift from cheek fillers not only improves the contour of the face but also, the has an added advantage of subtly lifting the face. If you’re looking for gentle and natural looking results for a lift to your face, cheek fillers is a good consideration. Cheek fillers also have the additional benefit of replacing volume loss in the cheeks related to aging. I find that the cheek is where a little filler can go a long way in making a patient look better- softened laugh lines (nasolabial folds), ‘lifted cheeks’ and reduced dark eye circles are some of the benefits of cheek fillers.
Update July 2020:
For an updated and detailed post on what it’s like to get cheek fillers in Singapore, please read this blogpost Getting Cheeky: A Guide to Cheek Filler Injections.
Two of the main reasons why patients in my clinic in Singapore get cheeks fillers are (1) face lifting (i. e. part of the Liquid Facelift); and (2) Face contouring.
What happens to our cheeks as we age?
One of the first signs of aging on the face is the loss of the medial cheek fat, before the cheeks become hollow and sunken looking. This leads to a loss of cheek volume and a sunken appearance and can appear as early as in our mid 20’s. The malar fat pad (cheek fat) also starts to shift downwards and laterally as we age because the ligaments holding the malar fat pad in place weaken and this results in the prominence of the NLF.
Atrophy of the subcutaneous fat result in loss of cheek volume and loss of support for the facial structures, resulting in a hollow cheek appearance. Loss of skin elasticity also contributes to the hollow cheek appearance.
The Ogee Curve and Facial Proportions
The Ogee curve is the central facial triangle or the double soft-S curves that are seen on the youthful face from an oblique angle. Fullness in the outer brow that gently curves where the upper and lower eyelids meet. This is followed by a soft convex curve on the upper cheek and then a concave bend just above the mouth. As we age, the natural curve collapses (for reasons explained above) as the face loses the volume and support in the cheeks. In facelift surgery and liquid facelift with fillers, one of the aims is to restore the Ogee curve for a youthful appearance.
An excellent way to correct this Ogee curve and volume loss is with the use of dermal fillers in the cheeks. Cheeks fillers replace this lost volume in the apple of the cheeks that has sunk downwards. Cheek fillers, when placed correctly, can create a lift that improves the contour of the cheeks and lifts downturned mouth angles and nasolabial folds.
When cheek fillers are injected as part of the Liquid Facelift to lift the cheeks and laugh lines (nasolabial folds), 2-3 injections are usually required for each cheek. Cheek fillers can lift the face and restore the contours and face volume of a younger looking face without becoming overfilled or the dreaded pillow face look.
When it comes to the cheeks, less is more and just a little cheek filler can refresh and enhance the appearance of your face without anyone knowing! Natural looking results will always be in vogue.
The use of cheek fillers is not solely limited to people who have signs of aging. In fact, younger patients can improve their facial profile with cheek fillers too! Most Asians are not blessed with the naturally high cheek bones of Caucasians and having a flat cheek is a common feature among East Asians.
Image credit: SCMP.
The shape of the cheeks is affected by the shape and structure of the cheek bones (i.e. maxilla and zygomatic bones) and the soft tissues overlying the cheek bones (i.e. cheek fats, muscles and skin).
A survey among plastic surgeons showed that the most commonly requested face by patients is Angelababy. The Ogee curve of her cheeks to her upper and lower face is harmonious and pleasing to the eye.
There is a scientific approach to understanding beauty and facial aesthetics. As explained earlier, the Ogee curve of the cheeks as it transitions from the eyebrows to the cheeks and to the mouth, provides a profile that is in harmony with the whole face. Having flat or sunken cheeks leads to the loss of the ideal facial profile, the Ogee curve.
Cheek fillers is a lunch time clinic procedure with almost no downtime. It can be done within 30 minutes for both cheeks.
The brands of dermal fillers that I use from Juvederm and Restylane contain a local anaesthetic mixed with the dermal filler, so there is very minimal pain, if at all. Nonetheless, I also apply numbing cream to reduce any discomfort for my patients.
After a thorough facial analysis, numbing cream is applied to the cheeks for 15 minutes. Once the skin is numbed, the face is disinfected and the filler is then introduced into the cheek either using a needle or a cannula.
There is very minimal swelling or bruising and you can return to work on the same day.
Dermal fillers are soft gels that are injected into the face to fill lines (e.g. laugh lines/ nasolabial folds) and static wrinkles; sculpt the face (e.g. nose and chin fillers); and treat sagging and volume loss (e.g. cheek fillers).
The most commonly used dermal fillers in Singapore are hyaluronic acid fillers. You may have heard of brands of dermal fillers like Juvederm, Restylane and Boletero which contain hyaluronic acid. There are other types of dermal fillers that are less commonly used such as Polycaprolactone (Ellanse), Poly-L-Lactic Acid (aka Sculptra) and Calcium hydroxylapatite (Radiesse). These non-hyaluronic acid fillers are also called collagen biostimulators.
When injected into the cheeks, hyaluronic acid dermal fillers plump up the face. Hyaluronic acid is a water loving molecule, so it also attracts water molecules to hydrate the skin. Hyaluronic acid dermal fillers last approximately for one year. They are also reversible; and can be dissolved with an antidote called hyalase.
The other 3 types of fillers are also classified as collagen biostimulators. Polycaprolactone (Ellanse), Poly-L-Lactic Acid (aka Sculptra) and Calcium hydroxylapatite (Radiesse) stimulate new collagen formation (hello anti-aging!) and so their results last for at least 2 years; longer than hyaluronic acid fillers. However the drawback with collagen stimulator fillers is that results are not immediately obvious as opposed to hyaluronic acid fillers, so no instant gratification there.
The collagen stimulator fillers also require a few rounds of injections in the same year and are not reversible. The implication is that if any of the complications of dermal filler injections occur like necrosis and blindness, the outcomes will be very worrying for the patient who has received the injections. You can read more about dermal fillers and the different types of fillers in this blogpost Botox vs Fillers: Differences, Uses, Effects and Myomodulation.
Are there alternatives to cheek fillers? How else can I enhance my cheeks or lift my face without fillers?
Besides cheek fillers, cheek implants can also lift the cheeks. However, cheeks implants are not as popular as cheek fillers and cheek implants require a surgery to introduce these implants. Secondly, having a permanent foreign body (implant) is not without its complications- implant infection requiring a surgical removal is a well-known problem of implants. Another issue is that as our faces change with age, the same implant may not look good on an aging face. Having fillers provides the flexibility to correct the different signs of aging that gradually appear.
You can return to your daily activities and work after cheek fillers. There may be very mild swelling after the fillers are injected and this swelling usually disappears in 1-2 days. Bruising very rarely occurs with cheek fillers.
The duration that cheek fillers last for will depend on the filler material used. The most commonly used filler material is hyaluronic acid and that can last 6-9months. Hyaluronic acid is a naturally occurring substance in your body and your body will gradually break down the filler material. You can choose to repeat your cheek fillers again if you would like to.
If you found this post on cheek fillers useful, you might find these educational reviews on dermal fillers also useful: