With every new procedure there is a wave of followers creating a new “trend.”  The fact is, if there is abundance of loose skin and sagging tissue on the face and neck then these areas have to be “lifted” to a more youthful position and then the excess must be judiciously excised – hence a facelift of some sorts.

If there is decent of tissue with loss of volume then “filling” the areas will lift things and harmonize the face and replenish fullness.  Incidentally, implants or fillers will give a similar result in many instances.

Occasionally the best result is achieved with a combination of these modalities.  For example some patients look amazing and youthful a few weeks after a facelift but then notice some areas of “aging” again fairly soon after surgery as the swelling subsides. In such a patient, “filling” with a filler or fat at the time of surgery would have resulted in a better long-term aesthetic outcome. Each patient is different so each patient requires a somewhat unique approach – to some extent.

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Many patients are interested in obtaining fuller more youthful cheeks.  Some have lost this fullness due to sagging tissue and loss of tissue volume as result of age.  Other have never had the ideal cheek or malar fullness as a result of genetic bony and soft tissue variations.

Options are numerous and depend on the patient’s age and anatomy.  Implants made in various shapes and sizes are great options.  Fat injection done in a series of 2 to 3 sessions will also result in naturally appearing fuller cheeks.  Fat can also be injected to the naso-labial folds at the same time if needed in older patients.  Filler injections although viable, were not cost effective until now.  Artefill, the first permanent “filler” approved by the FDA is a fantastic option for augmentation of the cheeks and effacement of the naso-labial folds.  Mid-face lift is also another option best used in older patients who have deep naso-labial folds and show inferiorly and medially descended cheeks.  This procedure may be combined with fat injection, filler injection or even cheek implants.

The ultimate goal is achieving a triangular face (with the base located between the cheeks and the apex at the chin).  This “inverted triangle” is associated with youth rather than the “rectangular face” associated with aging.

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