We’re not the only ones excited for the launch of Juvederm Voluma in the United States! The New York Times recently featured an article focused on facial volume and mentions Juvederm Voluma as a solution to mid-face volume loss.
As a clinical investigator already having injected over 500 syringes of Juvederm Voluma XC during the clinical study, Santa Rosa Facial Plastic Surgeon Dr. Victor Lacombe is eager to offer this procedure to the general public.
He will be one of the first physicians in California to perform Juvederm Voluma injections. Juvederm Voluma is expected to become available in the United States by the end of the year. To schedule a complimentary consultation with Dr. Victor Lacombe, please call (707)577-8292.
New Beauty Goal: Plumper Cheeks
By SALLY WADYKA
Published: September 25, 2013 in The New York Times
Like many people, Christina Conti, 44, a personal assistant from Wantagh, N.Y., was seeking a more youthful appearance. “I have a very thin face, and with that signs of aging come much faster,” she said. “I lost volume in my face over the years.”
Ms. Conti tried fillers in her nasolabial folds, the so-called marionette lines that run from the nose to corners of the mouth.
“It helped with those wrinkles but didn’t give me back volume,” she said. “Doing the folds wasn’t enough.”
Then her dermatologist at Spatique Medical Spa in Smithtown, N.Y., Dr. Marina I. Peredo, suggested injecting filler not into Ms. Conti’s wrinkles but into the flesh of her cheeks.
“It gave me back definition I had 15 years ago,” Ms. Conti said. “People said; ‘Wow, you look great. You look happy.’ ”
There’s a reason for the phrase “baby face.” Round, plump cheeks look young. Saggy, sunken ones look old. Increasingly, dermatologists and cosmetic surgeons are turning their attention from smoothing out wrinkles to increasing volume.
Dr. David E. Bank, the director of the Center for Dermatology, Cosmetic and Laser Surgery in Mount Kisco, N.Y., said that he and his colleagues “used to take a very two-dimensional approach to facial rejuvenation. We’d see a line and fill it.” While filling in wrinkles could make people look better, it did not necessarily make them look younger.
“Instead of looking 25 again, they just look like a 45-year-old without wrinkles,” Dr. Bank said.
But when volume is restored to the face, it conveys youth, he said.
Dr. Joel L. Cohen, the director of About Skin Dermatology and DermSurgery in Englewood, Colo., said that “we’re filling the smile lines less often and hitting the key points in the cheeks instead.” Doing that, he said, not only adds volume to the cheeks but also softens and helps lift the folds by the mouth.
Patients have been slow to come around to this newer thinking, doctors said.
“Nine times out of 10, people don’t realize what the real problem is,” said Dr. Peredo, who is also an assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York.
But this may change with the expected approval by the Food and Drug Administration of Voluma, a form of Juvéderm formulated (and marketed) to address midface volume loss. It is already being used to plump up cheeks in Europe and Canada.
Young faces conform to what dermatologists call the “triangle of youth.” That means that if you drew a line across the highest part of the cheeks from ear to ear, and then completed the triangle by drawing lines down to the chin, the widest part of the face would be at the cheeks.
“But as we age, the cheeks deflate and excess skin falls toward the jawline,” Dr. Peredo said. “That makes the triangle flip upside down so that the widest part of the face is now at the jawline.”
Several factors cause faces to deflate as they age. The skeletal structure thins, so the cheekbones actually recede and get smaller. The medial fat pad, which gives young cheeks their pleasing plumpness, thins out and moves down, tugged by gravity’s relentless toll. And collagen production slows, so skin is no longer as thick and firm as it once was.
Dr. Bank and a committee of four other doctors last year helped develop a tool to measure these changes, the Medicis Midface Volume Scale. It consists of four grades: Grade 1 is a full, youthful cheek; and Grade 4 is an indented, hollowed-out one. A reason for creating it was to help standardize the way doctors use fillers and prevent their using too much.
“If Grade 1 is the mutually agreed upon optimal end point, it will help guide how much filler to use,” Dr. Bank said. “One of the risks when doctors and patients don’t communicate about an end goal is that the doctor could end up overfilling, which can leave the face looking distorted.”
And while many patients may think more is better, very few really strive to achieve the chipmunk-cheek look that comes from too much filler.
In the United States, the tool of choice for recreating natural-looking cheeks is a hyaluronic acid filler like Restylane or Perlane. Radiesse, which is made from calcium hydroxide (a synthetic substance similar to that found naturally in bones) is another option.
“Fillers are rated for viscosity and lift capacity on a scale called G prime,” Dr. Cohen said. “Perlane and Radiesse both have high G prime, so they are ideal for adding volume to the cheeks.”
Regaining the cheeks of your youth takes relatively little time, and the only common side effects are swelling and bruising from the injections.
“Using a blunt-tipped cannula to deliver the filler has been shown to lessen bruising, swelling and also pain,” Dr. Cohen said. The doctor uses a needle to make a tiny nick in the skin, then inserts the cannula to deliver the filler deep into the cheek, laying it down just over the bone.
The cost of new cheeks varies, depending on how much reinflation the face needs, but expect to spend about $1,200 to $1,600, Dr. Bank said. And because the cheeks are not a high-movement area, fillers can last up to a year. Moreover, he said, “Injectable fillers stimulate the skin to make more of its own collagen, so each subsequent time you may need less and be able to go longer between treatments.”
Cheek implants (little silicone pouches surgically inserted over the cheekbone) are a permanent way to fill out a hollow face, but they are falling out of favor.
“They’re really best for someone who has a deficiency of cheekbones, not of fat,” said Dr. Goesel Anson, a plastic surgeon in Las Vegas. “I use implants for replacing bone and fillers for replacing lost volume. To get the best results, you need to replace like with like.”
And Ms. Conti, at least, likes “like with like” a lot. “I would do it again in a heartbeat,” she said.
This article has been revised to reflect the following correction:
Correction: October 3, 2013
The Skin Deep column last Thursday, about achieving fuller cheeks, misidentified the academic position held by Dr. Marina I. Peredo, a dermatologist. She is an assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York, not a clinical professor.
A version of this article appears in print on September 26, 2013, on page E3 of the New York edition with the headline: New Beauty Goal: Plumper Cheeks.