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Restoring lost volume and contours to the cheeks and reducing the appearance of deep smile lines volume

A balanced well-defined cheek structure is one of the most important elements of facial beauty irrespective of age, race, gender and culture. High outer cheekbones in a female are associated with facial attractiveness. Furthermore, fullness in the mid-cheek area with a smooth, curved contour conveys health and youthfulness. Strong cheek structure in a male is also associated with masculinity, attractiveness and health.

Cosmetic hyaluronic acid (HA) fillers can enhance the cheeks and provide foundation and support in the mid-face helping to reduce nasolabial folds (‘smile lines’) and under-eye hollows. By using different densities of fillers placed at different layers of the soft tissue, they can create lift, projection, definition and contour in the cheek and general mid-facial area. The outer cheekbone area can be made to look more sculpted, the front part of the cheeks under the eyes more volumised, and the malar eminence (the most prominent point on the cheekbone) more defined. Once the support in the mid-face has been achieved by treating the cheeks, the nasolabial folds can then be softened further if necessary with direct treatment of the folds with a softer type of filler for optimal natural-looking correction.

Sloave Clinic London

Treatment Overview

icon-clock How long is the procedure?

An initial appointment usually involves a detailed consultation with Dr Rhobaye for a tailored treatment strategy of 45-60 minutes. The actual injection stage takes only 10-20 minutes but can be significantly longer if combined with other treatment areas.

icon-needle How comfortable is the treatment?

Cheek and nasolabial fold treatments with fillers are usually tolerated very well. The premium cosmetic fillers that we use for the cheeks contain a local anaesthetic to reduce any discomfort significantly.

icon-heart How long is the recovery time?

Non-surgical cheek and mid-face enhancement and nasolabial fold reduction is a minimally invasive technique with significantly less risk of complications and downtime compared to surgery. You can return to work or your usual routine immediately or very soon after treatment.

You may experience some very mild swelling and occasionally bruising, which can take a few days to settle. Should bruising occur, they can be adequately covered up with makeup.

You will be advised by Dr Rhobaye on the expected recovery time so that you can plan a suitable procedure date. If requiring treatment before an important event, please book ahead allowing time for both the treatment and a 2-3 week follow-up review.

icon-eye When will I see results?

The results from hyaluronic acid filler treatments are immediate, and you should expect a noticeable improvement straight away. However, these results will develop further as the fillers undergo a process of integration and compaction, which can take some time to complete. There will inevitably also be a degree of minor soft tissue swelling which needs to resolve to assess the treatment outcome. Consequently, the final stable results can take several weeks to appear, typically 4-8 weeks.

results How long do results last?

The results from cheek enhancement and nasolabial fold reduction may last between 12-24 months or even longer in some individuals. Although HA fillers are classified as temporary, results can persist for a long time such that the baseline is improved with each treatment. This, in turn, means that you need less filler to maintain the same results and that the results can last incrementally longer with each treatment, especially if undertaken as part of a maintenance programme.

icon-calendar How many sessions will I need?

This will be discussed during your consultation as it varies from patient to patient and on the treatment area and desired result. For certain patients, only one session is necessary, whereas others may require several staged procedures over some time. We usually recommend that patients seeking further treatment allow at least 2 weeks (preferably 4 to 6 weeks) before undergoing additional filler procedures within the same area. After an optimal cheek and mid-face structure is achieved, then only occasional smaller maintenance treatments are required perhaps once every 12-24 months. Correcting nasolabial folds almost always involve addressing cheek volume loss and providing outer cheek support first as this can indirectly significantly improve the smile lines. Once optimum cheek structure is achieved, then the remaining smile lines are treated directly.   

natural-icon Will it look natural?

A fundamental principle in our treatment philosophy is that the results have to look natural. We take great care and skill in achieving this through a carefully planned treatment strategy that is highly individualised to each patient’s specific facial anatomical features. Dr Rhobaye is a highly experienced specialist and leading authority in non-surgical and minimally-invasive facial aesthetics. He uses advanced methodologies and techniques incorporating higher-level treatment philosophies that consider the face as a whole to achieve a very natural-looking appearance without distracting or disproportionate features. It is a comprehensive treatment strategy for full facial rejuvenation using the very latest and most advanced filler and neurotoxin technology.

Please look at our Photo Gallery for examples of our work.      

reverse Can the treatment results be reversed?

Our experience with non-surgical cheek, mid-face enhancement and smile line correction is that the patient satisfaction rate of this procedure is extremely high. Nevertheless, one of the main advantages of using hyaluronic acid (HA) fillers is that the procedure is reversible. If a patient wishes to reverse the changes for any reason, a particular enzyme (hyaluronidase) can be injected into the treatment area to dissolve the HA filler.

Disclaimer: Individual results and reactions may vary and can be affected by factors such as anatomy, physiology, metabolism, physical as well as environmental stresses, and fluctuations in body weight.

Sloave Clinic London
  • Improving facial proportions through a cheek and mid-face enhancement

    In both males and females, cheeks are the key determinant of mid-facial dimensions and together with the lower face (jawline and chin) will define whether the face is wide, narrow, long, angulated or round. Changes in the cheek area will, therefore, substantially affect the proportions of the face. An imbalance in facial proportions will have a significant negative impact on the overall attractiveness, even if specific areas in isolation are perceived as beautiful. Consequently, the shape and volume of the cheeks can have quite a dramatic impact on the overall aesthetics of the face through both localised and global effects.

  • Importance of maintaining good cheek structure

    Maintaining or acquiring good cheek structure and adequate volume is essential to not only provide support to the directly overlying soft tissue (skin, fat, muscle and ligaments) but also to the neighbouring and more distant regions of the face such as the tear trough area, nasolabial folds (“smile lines”) and even corners of the mouth.

    In young patients, this is important to help maintain or achieve better facial proportionality. In older patients, good cheek structure helps reduce the formation of grooves and folds including hollowing under the eyes as well as to counteract the normal progressive descent of the soft tissue that occurs during ageing and is evident as facial sagging. Some individuals maintain a youthful appearance despite ageing, and this can often be attributed to good cheek structure.

  • Normal cheek anatomy

    The cheek area is composed of both the facial skeleton and overlying layers of soft tissue containing skin, fat, muscles and ligaments. The cheekbones act as a rigid support and anchor point for these soft tissues and convey shape and dimension through them to the skin surface. The overall shape and cheek profile is, therefore determined by both the bone and overlying soft tissue.

    The facial soft tissue is mainly composed of fat divided into superficial and deep layers with the facial muscle layer (SMAS) in between. The superficial and deep fat are further divided into anatomical compartments. The superficial fat compartments are fairly mobile and move freely with contraction of the underlying SMAS muscle layer to permit facial expressions such as smiling. The deep compartments are more fixed in position attached by ligaments and fibrous attachments to the underlying bone and provide cushion support or buffer from the bone for the overlying SMAS layer during muscle contraction.

  • Changes to cheek anatomy during ageing and aesthetic consequences

    During the ageing process, these different fat compartments go through a complex progressive but specific pattern of volume change. Most of the fat compartments, principally the deeper ones, loose volume, whereas some of the superficial compartments gain volume. Furthermore, the ligaments and muscles that hold these compartments in place begin to weaken and loosen, leading to downward displacement and separation of the fat compartments. These changes are accompanied at the deeper level by gradual reabsorption of the mid-facial (maxillary and zygomatic) bones resulting in loss of structural support and projection with visible flattening of the cheeks. The loss of outward/side projection and hence the width of the cheekbones due to bone reabsorption effectively narrows the middle of the face relative to the upper and lower face. This, in turn, can negatively impact the proportions of the face and overall attractiveness.

    As the deep fat compartments lose volume and anchoring ligaments and attachments weaken, the superficial fat compartments begin to migrate over the deep compartments and separate such that the once smooth cheek contours start to develop surface irregularities and grooves. The differential pattern of volume loss and volume gain between the deep and superficial compartments and separation and migration for the superficial compartments lead is noticeable in the mid-face as deepening of the nasolabial folds as well as marionette lines that develop from the corners of the mouth.

  • Using cosmetic fillers to enhance the mid-face aesthetic appearance and improve facial proportions

    Modern hyaluronic acid (HA) fillers come in different densities with specific qualities that can be used to target each soft tissue layer of the face from the deep layer over the bone to the superficial layer just under or in the skin. Consequently, depending on the type of filler injected, they can be used to create lift, projection, definition and contour in the cheek and general mid-facial area.

    The outer cheekbone area can be made to look more defined and, where necessary, provide better outward/sideward projection to improve the width of the midface relative to the lower and upper face. This, in turn, can improve the overall shape and proportions of the face and attractiveness as well as providing lateral soft tissue support to aid against facial sagging. This effect is further enhanced by treating the areas of volume loss just below the outer cheekbones (the sub-zygomatic region), which helps create a platform for the overlying soft tissue helping to reduce mid-face heaviness and sagging. 

    Treating the front part of the cheeks under the eye area with fillers in patients who lack good forward cheek projection can help recreate the convex contour of youth and allow a smoother transition with the outer cheekbone area.

  • Using cosmetic fillers in the cheek area to improve the appearance of other areas of the face – the concept of myomodulation

    Treating both the inner and outer areas of the cheeks with cosmetic fillers can also significantly improve both neighbouring and more distant regions of the face.  Replacing lost volume in the inner or front part of the cheeks can support the area under the eyes and reduce the appearance of under-eye hollows as well as hide mild to moderate eye bags, particularly when combined with outer cheekbone injections.

    Injections into the deep cheek fat compartments either side of the nose in an area called the piriform fossa, as well as the outer cheekbones, provides support for the overlying fat compartments pushing them upwards and outwards, helping to significantly reduce the nasolabial folds (“smile lines”). Injections into the piriform fossa also help lessen a ‘gummy’ or ‘snarly’ smile and can narrow the apparent width of the nose.

    Finally, injecting filler in the outer cheeks can help lift the corners of the mouth when the filler is placed under one of the smile muscles (zygomaticus major) that runs from the outer cheeks to the mouth corners. The filler acts as a fulcrum for the overlying muscle giving the muscle a mechanical advantage, and hence increasing its ability to pull on the corner of the mouth. This process is an example of myomodulation i.e. the ability of fillers to improve or inhibit muscle action. It is an important mechanism by which treating one area of the face can enhance another, often more distant, area of the face.

  • Non-surgical cheek filler enhancement versus surgical implants and fat grafting

    Since the cheek structure is defined by both the bone support and overlying soft tissue, aesthetic enhancement of this area can be achieved by either augmenting the bone (with surgical cheek implants) or augmenting the soft tissue (with fat grafts or volumising fillers).

    Surgical implants provide direct local enhancement of the underlying facial skeleton, which is conveyed through the overlying soft tissue to the skin surface through an expansion effect and acts as a support platform for those tissues. In contrast, fat transfer restores fat volume and fullness in the fatty layer of the face between the skin and bone.

    Cosmetic cheek fillers, depending on the depth of injection and the type of filler used, can provide both structural support for the overlying soft tissue (when injected just above the bone), fullness in the mid-layer of the face (when injected at the mid-fat layer depth) and also superficial contour smoothening to correct surface irregularities such as grooves and hollows (when injected at the superficial fat layer). Both cosmetic fillers and fat can have a more diffuse area effect than surgical implants, depending on the size of the area treated and volume used.

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    Sloave Clinic London

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    Sloave Clinic London