Dermal fillers to restore those cheekbones
Plastic surgeon explains what you need to know about this procedureBy Marge C. Enriquez, Contributor
Philippine Daily Inquirer
In an age when youth is a cultural obsession, looking better through the years without telltale signs of enhancement has become a beauty norm. Some will go for plastic surgery to delay the effects of aging. Avoiding the inconvenience of downtime, others will favor injectibles as the nonsurgical way to a fresher appearance.
Dr. Rene Valerio, chair of the plastic surgery department of St. Luke’s Medical Center Global City, said more and more patients have been coming for minimally invasive procedures such as Botox, filler injections, and a combination of both for patients distressed with furrows and puppet lines on the face.
Many patients have been taking to autogenous fat transfer, or the patient’s own fat for facial rejuvenation. Although the results are natural and safer, the procedure is more time-consuming and expensive.
“The fat has to be harvested through liposuction. Some patients don’t want additional incisions. So they will prefer dermal fillers using hyaluronic acid. It is more affordable and has minimal downtime,” said Valerio.
Fillers for cheek, nose, chin
After a person turns 30, collagen, the naturally occurring protein that provides firmness to the skin, starts to decrease. During the launch of Juvederm Voluma, the new generation of hyaluronic fillers, at Oakwood Joy Nostalg Center, Valerio was tasked to assess the face of a 36-year-old professional.
He pointed out the subject’s volume depletion in the anterior cheek area (from under the eye to the side of the mouth) where the early signs of loss of elasticity occur.
“They’re beginning to droop,” he said. “You need to restore the volume of the cheek to rejuvenate it.”
In his practice, Valerio observed that younger patients will ask for augmentation of the underdeveloped nose bridge or, in Tagalog, pango. “The filler injection on the tip of the nose (the columella or the bridge running from the tip of the nose to the upper lip) helps to raise the tip for an adequate projection.” Thus, the beauty ideal, matangos na ilong.
For patients with a weak chin, the filler adds prominence. “The result is elongation of the face. The oval face is the ideal,” explained Valerio.
The plastic surgeon said most of his patients are women. Between the ages of 40 and 60, they require more fillers for rejuvenation and restructuring the face. “Instead of the facelift, there are eight main areas for injections for facial rejuvenation,” he said.
Previously, baby boomers and Gen X’ers only went for fillers to address the nasolabial folds, or the marionette lines and lips. Now they’re having it done on the cheekbones and the jawline to improve the appearance of the jawline.
Fillers are still used to augment plastic surgery. “Facelift and necklifts aren’t always enough to rejuvenate the face. You have to combine filler injections after the last stitch to restore the volume that has been depleted. Usually it is in the cheek area,” said Valerio.
At the press conference, Valerio showed “before-and-after” photos of how dermal fillers improved people’s looks by defining the nasal tips and making the cheekbones more prominent. There were “before” photos of patients with rectangular faces due to sagging jowls and heavy cheeks. The “after” photos showed their faces coming close to the ideal oval shape as a result of dermal fillers.
“All procedures carry risks of complications, which can be avoided with proper selection of patients,” said Valerio. “Likewise, patients should consult with highly qualified and licensed physicians and shouldn’t get unrealistic expectations.”
He has had cases of patients, who have come from other aesthetic centers, coming to him with botched jobs as a result of too much injections. “If you don’t target the right location, you will end up using a lot of filler material. The doctor must be accurate in identifying the areas that will recreate some lift with the fillers.”
There have also been patients who complain of swollen cheeks or lips that look as though they’ve been bee-stung. He also warned of silicon oil that is used in some dubious aesthetic centers. “Silicon is a permanent filler. It is difficult to remove because it sticks to the muscles, tissues, subcutaneous tissues and dermal tissues. You can only improve it minimally,” said Valerio. “It’s very obvious when you see some old movie stars with silicon oil injections especially on TV. The cheeks droop to create a lion appearance.”
Hyaluronic acid is the more popular and FDA-approved filler. “Hyaluronic substance is a natural-occurring substance. It doesn’t stay in the body for a long time. That is why you need to retouch,” he said.
Dermatologist and Allergan Philippines medical affairs manager Camille Angeles added: “As we age, our muscles become thinner. Our fat in the skin disappears, or what is called fat atrophy. There is volume loss in certain areas of the skin. But there is also volume retention in areas where you don’t want them to be. All these contribute to facial aging.
“As we get older there is jowl formation. The face loses its triangular structure. There is fattening of the mid-face; the jawline is not nice; there are thin lips, the eyebrows are not in place. You have this tired look brought about by the volume loss in the mid-face. Nasolabial folds will deepen. Hyaluronic acid is the most widely studied type of dermal fillers. Documented to be safe and effective, it has been the standard treatment for correcting facial lines and folds and, recently, to restore volume or create structure.”
Allergan is making a bid to lead the market with Voluma. This filler has a patented Vicross technology, which has a more cohesive formulation that guarantees longer effects. Other hyaluronic acids would last for six to nine months. On the other hand, Juvederm Voluma can last from 18 to 24 months.
“Allergan manufactured the filler by changing the proportion of the ingredients,” said Angeles. “The particles stick together and don’t spread out as much compared with the other products. This clinically translates to a smoother appearance on the face and the chances of it spreading to other areas—where you don’t want it to go—will be less.”
Angeles cited an Australian study that 95.6 percent of doctors saw dramatic improvements with Juvederm Voluma.
On the right time to use fillers, plastic surgeon Gerald Sy replied, “It’s not a matter of getting old, but of maintaining that beauty. If you see changes, such as depression or loss of fat, with all the technology available, it’s better to do it early than late. It’s not about vanity but maintaining self-esteem. When former classmates see you, they’ll say, ‘You haven’t changed.’”