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    High cheekbones as a beauty ideal

    Beauty is debatable, but attractiveness is not. A review of 1800 scientific studies shows that there is strong agreement both within and across cultures about who is attractive and who is not (Langlois JH, et al, 2000, Psychol Bull). Facial attractiveness determines not only first impressions of strangers, but also who we talk to, who we get to know, and who we pay attention to. The following features are generally perceived as attractive:

    • Symmetry
    • proportions, which are particularly prevalent among young people, and
    • Proportions that are characteristic of men or women (Perrett D.I., et al., 1988, Nature).

    A person’s gaze intuitively falls first on the cheekbones when viewing a face from the side or in semi-profile (Saether L., et al., 2009, Vision Res). To enhance the impression of high cheekbones, light-shadow effects are commonly created with makeup. Proportionality often determines whether a facial feature is attractive or not. In symmetry, the cheekbone of one side is set in relation to the other side. A width ratio of the lower jaw in relation to the cheekbone of 75 percent is considered most attractive in women (Wu TY, et al., 2020, J Chin Med Assoc). High cheekbones in relation to the lower half of the face are attractive in both women and men. However, high cheeks have a greater effect on facial attractiveness in women (Woo H.K., 2020, Head Face Med). A ratio of the distance between the cheekbones and the chin and the distance between the corner of the eye and the chin of 80 percent appears attractive (Kaptein Y.E., et al., 2015, Plast Reconstr Surg Glob Open). Based on scientific evidence, aesthetic treatment emphasizes individual features to help the face become more expressive. In the hands of experienced specialists and taking into account harmonious proportions, 94 percent of patients are satisfied with hyaluron injections of the cheekbones (Li D, et al., 2017, Plast Reconstr Surg).

    Cheek augmentation for a round face?

    Chubby cheeks and a double chin disguise the contours of the cheeks. Beautiful cheeks come from a gently curved transition from the cheekbones to the lower jaw, giving the face a youthful appearance. The curved contour comes into its own best in the half-profile view. The S-curve of juvenile high cheeks is called the “ogee curve” in American parlance. There are different approaches to emphasize the expressiveness of a round face and to realize the desire of defined, fresh and youthful facial contours. Hyaluronic acid treatment can help the side cheekbones and chin look more prominent and tighten the skin. The appearance is improved according to the wish and the natural facial expression is maintained. The injection of a neuromodulator substance into the masseter muscle also helps to achieve a slimmer shape. The combination makes it possible to harmonize the desired result of the cheek build-up in the entire face. In addition, the eyebrows can be slightly raised with a neuromodulator substance. A fat removal injection is able to correct a double chin or sagging cheeks.

    How does the face change with age

    Age-related changes of the face as well as the so-called hollow cheeks increase from the age of thirty. Genetic predisposition and lifestyle habits such as cigarette smoking and frequent sunbathing (UV radiation) can accelerate these processes and increase volume loss. On the other hand, it is less related to severe weight loss. As women age, more specifically between the ages of twenty-five and forty-five, bone loss occurs, which also affects the cheekbones. The hollow cheeks are also caused by the age-related slackening of the connective tissue: the fat pads of the cheeks slip off. The fatty tissue recedes, which makes the sunken cheeks manifest themselves even more. The facial muscles are stretched and the range of motion of the muscles decreases with age. The change in the skin leads to sagging and wrinkles.

    All these changes cause the formation of wrinkles between the nose and the corners of the mouth (nasolabial folds) and wrinkles between the corners of the mouth and the lower jaw (marionette lines), as well as dark circles under the eyes. The facial expression may appear tired or sad, although the affected person does not feel exhausted or sad. The aim of the hyaluronic acid treatment is to bring the facial expression back into harmony with the state of mind. For this purpose, a holistic treatment of the sagging contours with this active ingredient makes sense.

    What is the liquid lift?

    Studies show that in old age the deep fat deposits in the face in particular lose volume (Rohrich RJ, et al., 2008, Plast Reconstr Surg.). As a result, the skin and superficial tissues sink. The skin is anchored to facial muscles or bones at certain points and can therefore hardly sink. If the surrounding tissue slackens with age, furrows tend to form at the attachment points. Cheek furrows (“mid-cheek crease”) arise on a connective tissue anchorage between the skin and cheekbones (“zygomatic cutaneous ligament”). Dark circles form at the point of attachment of a band between the skin and the edge of the eye socket (“orbicularis retaining ligament”, “orbitomalar ligament”, “arcus marginalis”). At the nasolabial fold, the skin is connected to several muscles of the mouth. With a hyaluronic acid treatment, the lost volume of the cheeks is replaced. The restoration of volume gives the cheeks more beautiful contours. A precise injection above or below the facial muscles can improve the power transmission of the muscles. The injection restores harmonious, youthful contours and improves the natural expressiveness of the face. The volume build-up creates a certain tightening effect in which the folds between the nostrils and corners of the mouth (nasolabial folds) are softened. The injection of a relatively small amount of hyaluronic acid already leads to a lifting effect with correction of the dark circles and softening of the nasolabial folds and sagging cheeks. The results are immediately visible. However, filler treatments cannot be compared to face lifts. Hyaluronic acid cheek augmentation can significantly rejuvenate the face and delay the need for surgery. A face lift to rejuvenate the lower half of the face is much more effective if the skin is noticeably slack. For a natural and satisfactory liquid lift, the treatment must be appropriate and holistic. Proportionality to other areas of the face such as the temples, forehead or cheek contours should be preserved with the hyaluronic acid injection.

    How is the cheeks injected?

    Our goal is to underline the facial features that give your face an individual note of beauty or specialty. Characteristics that seem unattractive can be softened by a hyaluronic acid treatment. For a balanced result, your facial contours will be examined and a treatment plan tailored to you will be drawn up. Many patients want an injection immediately after the consultation. After all of your questions have been answered, a numbing cream will first be applied for your comfort. The skin is then thoroughly cleaned with alcohol and disinfected. A concentrated hyaluronic acid is infiltrated near the cheekbones. Slightly smoother fillers are better suited for building up superficial fat deposits. This results in a more harmonious distribution of hyaluronic acid and an improvement in the moisture content and surface structure. The superficial injection stimulates the connective tissue cells (fibroblasts) and increases the formation of elastin and collagen in the tissue. With cooling pads you can prevent swelling or redness immediately after the injection. After the treatment, you will be given a filler pass in which the trade name and batch number of the hyaluronic acid are documented. In order to ensure the best possible result, we will give you a couple of behavioral recommendations. You will be given a number so that you can contact your doctor at any time in case of doubt. We offer our patients an appointment about two weeks after the injection to convince us of their satisfaction.

    How much hyaluronic acid for the cheek build-up?

    A harmonious and natural result is our priority. The question of how large the amount of the preparation must be in order to optimally soften the sunken cheeks through cheek injections varies from individual to individual. To do this, the specialist and expert in aesthetic medicine must examine exactly what volume is required to make the cheeks, the jawline (jawline), the lips and the forehead look balanced, i.e. harmonious with each other and attractive in the overall picture. Using the same volume in the same place every time leads to stereotypical faces and does not meet the high demands of our patients or our practice. When treating the cheeks, contours are restored that have been lost due to the shrinkage of fatty tissue. These changes are age and gender dependent. The amount of product, site and depth of injection must be carefully determined based on sound knowledge of the anatomy. Before any treatment, it is essential to examine the contours and facial expressions. A good cohesion (cohesiveness) of the gel is important so that the hyaluronic acid does not slip under the influence of the facial muscles. Fillers with a high modulus of elasticity, i.e. slightly firmer gels, are very suitable for filling the cheekbones. For superficial treatment, more liquid gels are used. Depending on the findings, 2 to 4 milliliters of hyaluronic acid are required for 3-dimensional contouring. For an optimal result, not only the quantity and quality of hyaluronic acid is important. Make sure your doctor is experienced in the selection and application of treatment techniques. The combination of experience and this specific knowledge of the anatomy and the appropriate measures with the most suitable amount and technique of cheek augmentation with hyaluronic acid can only be found in an aesthetic plastic surgeon.

    Cheek augmentation for men

    The contour and fullness of the cheeks have special, characteristic differences in men and women. In men, the cheeks, especially the frontal process and the temporal bone process of the cheekbone are stronger [1]. A prominent chin and jaw contour, pronounced cheekbones and narrow cheeks develop under the influence of male hormones between the ages of 12 and 15 [2]. In men, the cheeks in the middle area are less protruding than in women [3]. Male facial features are often associated with dominance and social competence [4]. In fact, there is evidence that individuals with very masculine facial features have more muscle strength [5]. It is therefore not surprising that women rate men with prominent cheekbones more attractive [6].

    The cheek is a common problem area in men. Due to genetic factors, the zygomatic arch can be contourless in relation to the jawline or the eyebrows, which means that men also have to deal with the problem of sunken cheeks. In men, the facial bones break down between the ages of forty-five and sixty-five. While a beard can hide the chin-jaw contour, the outline of the cheeks tends to be accentuated by a beard hairstyle. Cheek injections can be used to accentuate masculine features or to build youthful cheeks. Overcorrection, especially injecting too much volume in the midsection, results in full cheeks and makes a face appear feminine. It is therefore advisable to consult an experienced practitioner to sharpen the contours of the cheeks with precision.

    How long does the cheek augmentation with hyaluron last?

    The effect of a cheek injection is immediate and therefore visible very quickly. The effect remains for more than one year. After 6 months, 90 percent of patients are satisfied with the results of cheek injections [7]. Studies show that over 70 percent of patients are still satisfied with the results after one year [8]. According to our many years of experience, even after 18 months, less hyaluronic acid is required for a further treatment in the frame (follow-up injection) than for the initial treatment. Of course, this depends on your personal metabolism. For lasting results, we recommend microfat injections. The autologous fat is considered a permanent filler. Since the so-called lipofilling method uses the body’s own substance, which is suctioned from the abdomen, for example, an allergic reaction is ruled out. You can find out more about the numerous positive effects of this procedure using the body’s own material on the page on lipofilling.

    Risks associated with injections of the cheeks

    No treatment is completely without risks. However, the risks of cheek augmentation with hyaluronic acid are usually low and the mild possible side effects are only temporary. Some swelling and minimal redness of the skin may also occur with the use of very fine needles. Gentle cooling helps to prevent swelling from occurring in the first place, or to reduce it after a short time, or more precisely within a few hours. Allergic reactions and inflammations are among the very unlikely risks. Unfortunately, it can never be completely ruled out that a small vessel may be injured during the injection. Rarely, hyaluronic acid can enter the bloodstream. It is even rarer for the hyaluronic acid to interrupt the flow of blood and compromise the blood supply to the skin, causing small bruises to form. The experienced doctors at CenterPlast are of course prepared for rare occurrences. Such complications can be managed by early recognition and immediate initiation of the necessary measures [9]. The most common undesirable effect of hyaluronic acid injections of the cheeks are unsatisfactory results, especially if the necessary experience and qualification of the user is not available. Injections by unqualified practitioners without a license to practice medicine and without precise knowledge of the anatomy are dangerous. More information about the general risks and side effects can be found on the page “Filler – Everything you need to know“.

    Hyaluronic acid or thread lifting?

    The cheeks already lose volume between the ages of 30 and 40 [10]. The changes are due to bone remodelling as well as to a loss of fatty tissue and a loss of skin elasticity. As the tissue sags, wrinkles develop between the nose and the corners of the mouth. With hyaluronic acid, the volume of the cheeks is restored without surgical intervention. As a result, the skin lifts and the nasolabial fold disappears. This technique is therefore also called Liquid Facelift and was described by the Brazilian plastic surgeon of Maracio de Maio in 2010. Thread lifting counteracts the force of gravity and returns the fat pads to their original position. So much for the theory, but which treatment is more effective? A comparative study suggests that both treatments are very safe but patient satisfaction is greater after filler treatment [11]. Satisfaction is particularly high with a combination of fillers and absorbable sutures [12].

    Filler or autologous fat for cheek augmentation?

    For a cheek injection of sunken cheeks two tissue fillers can be used in principle: Hyaluronic acid and autologous fat. In fact, there are studies that compare the methods. In doing so, they conclude that both methods are safe, and that more volume is retained after one year following autologous fat injections [13]. The own fat treatment, brings many advantages with it. This also applies to other regions of the face such as around the eyes or on the lips. Breast augmentation with autologous fat also promises excellent, very satisfactory and above all natural and lasting results. In principle, an autologous fat treatment can be carried out at any time on healthy patients, regardless of their body weight. The fatty tissue can be suctioned from the abdomen, hips, inner thighs or knees. The fat cells are then prepared in a separation process, filtered and injected at the desired location. As with all procedures involving living cells, autologous fat treatment has a certain loss rate. A certain percentage of cells may die during collection and processing or be broken down by the body during healing. This percentage varies depending on the patient’s age, health condition and lifestyle habits, as well as the behavioral measures taken after the injections. We have optimized the techniques of harvesting, preparing and injecting the cells so that about 70 percent of the cells grow permanently. Compared to hyaluronic acid, autologous fat is suitable for balancing a larger volume, for example for simultaneous treatment of the chin-jaw contour, lower eyelids, lips, nose, forehead, temples and earlobes. In addition, autologous fat treatment improves skin quality [14].

    Is there a cheek augmentation surgery?

    For cheek augmentation, an autologous fat treatment or hyaluronic acid injections are suitable. If the cheeks are particularly sunken, i.e. there is also significant sagging of the connective tissue and skin, a midface lift should be considered. This small operation, also called cheek correction, is used to treat bags under the eyes, dark circles under the eyes or to combat swelling above the cheekbone (“festoons”, “malar mounds”, “malar bags”). Lachrymal sacs develop above the bony edge of the eye socket due to slackening of the connective tissue ligament. Eye circles form below the bone edge of the eye socket due to sagging of the skin and shrinkage of the fatty tissue (“tear trough”). You can find out more about this technique and the exact treatment details on our cheek correction page.

    Cheek augmentation with hyaluronpen

    A hyaluronic pen is a device that injects a liquid through the skin at high pressure (0.5 bar to 17 bar). The liquid jet can be generated by different mechanisms:

    • Spring-operated injectors, such as the Dermojet from AKRA in France.
    • Pneumatic injection devices powered by an air compressor, such as EnerJet from PerfAction Technologies, Israel or Med-Jet from Medical International Technologies, Canada.

    The advantages of an injection with a high pressure gun are:

    • The small diameter of the beam of less than 0.2 millimeters.
    • The high speed of the injection of about 30 milliseconds [15].

    The disadvantages of a high pressure gun are:

    • Only very liquid substances can be injected.
    • A maximum volume of 0.3 milliliters can be administered per injection.
    • Only superficial penetration is possible.

    Immediately after penetrating the skin, the liquid jet is broken down into fine droplets and spreads in the tissue in an undirected manner. Hyaluronpens are not as harmless as the name suggests. Experienced plastic surgeons are familiar with the distribution pattern of fluids in tissue, as injuries from high-pressure spray guns are rare but dangerous. Hyaluronic pens are completely unsuitable for the treatment of the cheeks, as larger quantities of firmer hyaluronic acid must be injected deeply and specifically into the tissue by a specialist. Nevertheless, hyaluronic acid pens are widely used because the application, unlike hyaluronic acid injections, has not yet been regulated by law. An aesthetic treatment is a medical treatment. We therefore recommend that you entrust yourself to doctors who have a comprehensive knowledge of anatomy, hygiene and pharmacology. Make sure that they are always experienced experts in aesthetic and plastic surgery.

    How does a cheek injection work?

    This is a minimally invasive treatment. At the beginning of the hyaluron treatment the face is thoroughly disinfected. A local anaesthetic cream is then applied so that no pain is felt when the high-quality hyaluronic acid is carefully and precisely injected afterwards by the specialist in aesthetic surgery. CenterPlast also offers other options to help you feel completely comfortable and relaxed during your hyaluronic acid injection. On our page Filler – everything you need to know you will find all the important information about the procedure of a hyaluronic acid treatment. There you will also find answers to other frequently asked questions about wrinkle injections, the different products, hyaluronic acid as a medication and anti-aging agents. In order to be personally advised by the attending physician and to find out about a possible course of treatment in your individual case, you should make an appointment for a personal consultation. This is an important component when it comes to cheek injections. In the course of an appropriate examination, the exact prerequisites (personal requirements) and the individual risks are examined and the exact scope of the treatment is discussed. A comprehensive preliminary examination is always essential for patients.

    What are the costs for cheek augmentation with filler?

    Before cheek augmentation with filler, an examination and education & creation of a treatment plan is essential. However, if you want to know the price range in advance, simply use our price calculator.

    The cost of the service is calculated from the effort and the amount of injected hyaluronic acid. CenterPlast offers fair prices. We will also be happy to inform you about the possibilities of financing interventions. You will find everything on the corresponding page.

    Testimonials on cheek augmentation with filler

    Before patients decide to have cheek augmentation and choose a suitable experienced expert for the treatment, they usually search the internet for filler experience reviews. People who have already undergone the injections at the respective practice explain in such reports whether they were satisfied with the service, the consultation and of course with the treatment and the final result. If you’d like to find out more, visit our dedicated page which brings it all together.

    Before and after pictures of cheek augmentation with filler

    Before patients decide to have cheek augmentation, they often want to see before-and-after photos of such a filler treatment so they can visualize how the cheeks were filled in at this practice. Centerplast also offers the possibility of having before-and-after results shown during a preliminary consultation. You can find further information on this on our corresponding page.

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    The author

    Dr. Adelana Santos Stahl

    “Our goal is to provide the best, most discreet and precise treatment based on our extensive expertise in plastic surgery. „

    Dr. Adelana Santos Stahl is distinguished by a unique international perspective with a feminine view of plastic surgery. Her personalized and detailed approach is key to the beautiful and natural results she achieves. Having trained in Brazil, one of the largest and most well-known countries for aesthetic and reconstructive plastic surgery, she understands her patients’ desire to look and feel their best.She completed her medical studies and her training as a specialist for plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the medical state examination. Two years later, in 2011 she received the German and in 2012 the EU specialist recognition (EBOPRAS) for plastic surgery.From 2009 to 2013, she deepened her knowledge of aesthetic and reconstructive facial surgery with world-renowned representatives of plastic surgery such as Professor Gubisch at the Marienhospital and Madame Firmin in Paris.A VDÄPC Fellowship (continuing fellowship for graduate students) in Switzerland, France and the USA has further enriched her professional experience.Dr. Santos Stahl is active in several prestigious professional societies. Besides the DGPRÄC and DGBT, she is also a member of the Brazilian Society of Plastic Surgery – SBCP.She is also the author of several scientific articles and, together with her husband, is dedicated to research and clinical studies in the field of plastic surgery.

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