Thank you for your question.
You submitted a question without a photo however, the body of your question, you're essentially
asking about the longevity of cheek implants.
And further you have done some consultation and a plastic surgeon answered your question
about whether or not implants are screwed in and the plastic surgeon said that they're
never screwed in and that was a myth.
So I can understand your confusion and I can certainly help you understand my approach
to the world of cheek augmentation in my practice as it is currently.
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.
And cheek augmentation as part of facial rejuvenation has been something that I have worked on for
my entire career and everything from placement of cheek implants as well as fat grafting
as well as fillers.
So I'll tell you how my current approach is again to help you understand the thinking
and how I evolved.
So to begin with, when you do these types of consultations, you are certainly going
to be subjected to the biases of the practitioner who's offering you a solution.
So for example, typically speaking, dermatologists don't do surgical cheek implants.
So very often, if you only go to a dermatologist, you're going to get offered a lot of different
types of filler options.
Then when you go to plastic surgeons, even if they do some fillers, they may lean towards
doing surgical implants and will naturally give you a perspective on the benefits of
surgical implants.
And so I'll tell you first from the cosmetic surgeon's perspective as how I evolved from
what I was doing prior to what I'm doing now.
So a lot of times, patients who came who are a little bit older were frustrated that when
they were getting fillers placed into their cheeks, the cheek volume became kind of strangely
doughy looking and not so well defined.
And I explained at that time that essentially, when your skin is loose and the soft tissue
is loose, then you can't put that much filler in your face without it sagging.
So it became part of my routine that I would put like a cheek implant but I wouldn't
do it in isolation.
I would do it with a facelift procedure.
So that way, the cheek volume was restored at the structural level on the bone structure.
Now that's a certainly good solution and certainly worked very well.
And as far as to answer the question about whether or not cheek implants can be screwed
in, with due respect to the plastic surgeon colleague, yes, it is routine to screw in
a cheek implant with a titanium screw.
I don't know why that would be perceived as a myth.
One of the early approaches to doing cheek implants and still is a valid approach was
to use a suture to pass through an external part of the skin and tied over a bolster so
that the pocket of the implant would eventually, over several days, close down and then you
take the stitch out.
With titanium screws, you can actually fixate it more predictably in my opinion and in that
way, they can be more stable.
One of the things that is very important to understand and the longevity question definitely
exposes is although the implant can be in place for many years, your face changes.
The bone volume, changes.
The fat, soft tissue overlying, changes.
So one thing that has evolved in my practice is that when I see someone who has reasonably
good skin quality and tone is an alternative to cheek implant placement, we do something
called structural volumizing using long lasting fillers.
When I say long lasting, I'm talking about thicker fillers that are designed to last
longer such as Juvederm Ultra Plus or Juvederm Voluma.
Now it really has transformed my approach to helping my patients.
And of course as a surgeon, I can do both the injectables as well as the surgery.
But when I look at the practicality and the actual controllability, I have to say that
now I'm doing a lot more placement of filler using the technique of structural volumizing.
Now this is different from what I was describing earlier.
Most doctors and this is not just dermatologists but most practitioners, when they place a
filler, they place it at right below the skin level and try to enhance through molding of
the material under the skin to try to create the illusion of certain, like a cheekbone
perception or structure.
When I do structural volumizing, the technique involves placement at the bone level.
And so, it really helps correct what is the underlying issue which is bone loss.
With structural volumizing, I'm able to control volume very well.
I'm able to place at different areas of the cheek in a way that I can customize and
I'm actually able to try to maximize symmetry in the face that is always asymmetric.
Not to mention that the procedure takes only a few minutes to do as opposed to placement
of the cheek implant in the operating room.
With this kind of solution in mind, essentially, you can adjust what you do as the patient
gets older and deals with all the other factors that can affect cheek volume.
People go on different diets.
People lose weight for a variety of reasons.
And so, it can be a customized as things change in addition to normal facial changing.
So essentially, my thinking would be is that if you wanted to have a solution for the cheek,
and not only there, but you can place the material in the chin, the jawline, in the
jaw angle and create the effect of a facelift, if not one step beyond again based on the
type of anatomy and age of the patient, there are a lot more opportunities to do these things
in a customized way and do it without going into the operating room.
So I think that I would encourage you to pursue more research and meet more doctors and learn
more about structural volumizing as I described it and I think that you'll find yourself
maybe gravitating towards doing the injectables with this technique rather than commit to
a facial implant.
Again, there's nothing wrong with facial implants and certainly I'm very proud of
the ones I've done but I think that, now we have a lot more options and we want to
always hear what is right for the patient and try to solve the issue in the most practical,
safest and predictable way as possible.
So I hope that was helpful, I wish you the best of luck and thank you for your question.
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