Why do we get sunken cheeks?
The transition from perfect baby skin as a child to older, wrinkled skin of the elderly is a progressive process. This process involves all skin layers, muscles and the bones.
The skin becomes thinner, dehydrated and lax as it gradually loses more and more collagen. As a result, the skin loses its firmness and volume and begins to change due to lifestyle factors and gravity. Another significant factor is the loss of subcutaneous tissue and fat which form soft pads in some areas of the face such as the eyes, eyebrows or cheeks. As a result the cheeks collapse and the face loses its smoothing and rounding out contours which makes it look old and tired.
What is hyaluronic acid?
Hyaluronic acid is a natural ingredient of human skin. It is produced by fibroblasts which form the structural framework for human tissues. Hyaluronic acid fills intercellular areas and makes perfect environment for skin cells. It is also responsible for stimulating the production of collagen and protecting all skin elements from exposure to free radicals. Hyaluronic acid also contributes to tissue hydrodynamics; it is responsible for the amount of water tied in the skin which makes it an ideal moisturizing factor. However, over time human skin begins to lose its natural resources of hyaluronic acid which affects the work of fibroblasts. Consequently, the amount of collagen decreases which contributes to the loss in its volume. This process can be stopped with a single injection of hyaluronic acid to help your skin regain its youthful look.
Products rich in hyaluronic acid
There are many products rich in hyaluronic acid. Brands available on the Polish market include: Restylane, Juvederm, Succeev, Stylage, Teosyal. Each of the brands offers a wide variety of different texture, such as Restylane Vital (light texture), or Juvederm Voluma (rich texture).
Products rich in natural hyaluronic acid (Juvederm Hydrate) are mainly used for mezotherapy which instantly improves hydration and rejuvenation of skin. Other similar products are additionally supplemented with glycerine, glicerol and mannitol which make the product perfect moisturizers.
There is a variety of different dermal fillers depending on the area to be treated, ranging from hydrating fillers which are perfect for the décolletage, smooth fillers ideal for the lips or denser fillers for volumising which are most suitable for the cheeks. Sometimes a combination of fillers are used on a particular area to achieve the perfect result.
Products which are used at Ekoderm as dermal fillers all have a proven track record for safety and so you can be assured that they are perfectly safe. We use world’s best known brands such as Restylane, Juvederm and Succeev. Every client is unique so at Ekoderm our practitioners make sure that the best possible treatment is chosen for each individual client. To correct sunken cheeks we choose from a wide variety of treatments: Restylane Perlane, Juvederm Ultra4, Juvederm Voluma or Succeev Three.
How does the treatment work?
The product rich in hyaluronic acid is injected directly into the sunken cheek below the cheekbone. The treatment is performed with a needle which injects proper amount of the product with numerous punctures. This technique allows the doctor to cover a relatively large area with a fan of threads which provides support for the whole cheek. It can also be distributed from one or two punctures with special elastic cannula which makes it possible to bring the area “out” and restore its rounding out contours. Both techniques guarantee excellent results, the use of the cannula, however brings bruising to minimum. During the treatment the practitioner usually injects 0,5 ml of the product into each cheek. After the injection, the product is evenly distributed and massaged properly by the practitioner.
Do I need local anaesthetic?
Our usual practice is to apply an anaesthetic cream (Emla) 30-40 minutes before the injection. We can also inject the puncture sites with local anaesthetic which is normally used in dental surgery so that the area feels numb and discomfort is kept to minimum. In any case, however, the practitioner needs to be informed about possible allergic reactions.
Who is the treatment for?
The treatment is designed for any woman or man who feel uncomfortable with sunken cheeks. This usually happens at the age of 40, especially among slim people, but it still may be too early to have any treatments which correct such changes. The decision to undergo such treatments is very individual and it is usually taken when patients find it difficult to accept their aging, sad look caused by sunken cheeks.
What are the results?
After the treatment the collapsed cheeks are filled and the skin is smooth again. Bruises and shadows disappear. The face contours are rounded up which gives the face refreshed and youthful look again. The natural property of hyaluronic acid is to gradually absorb water and increase its volume so the volumising result of the injection is even more distinct many weeks after the treatment. Hyaluronic acid is also responsible for the production of collagen so the final result is replenished volume, firmer and younger looking skin.
When do I see the final results of the treatment?
The results should be expected after 3 to 4 weeks after the treatment. It is usually then that the practitioner together with the patient make the decision concerning additional treatments which are sometimes necessary when the changes are deep. It is easier to correct such defects gradually which means that sometimes more product has to be injected after 3 or 4 weeks. It usually takes another 3-4 weeks before the final result can be enjoyed.
How many treatments do I need to see satisfactory results?
Younger patients, under 40 years of age, are usually satisfied with a single injection of 1 ml to 2 ml of hyaluronic acid. To see satisfactory results, older patients usually require another treatment performed after 3 to 4 weeks.
How long do I see the results of the treatment?
Satisfactory results, which have been achieved after 1 to 2 treatments, can usually be enjoyed for 12 -18 months. This period of time depends on the patient’s age, the kind of the filler as well as the patient’s general physical condition. It must be emphasized that smoking can significantly diminish the results of the treatment.
How often do I need to repeat the treatment?
The treatment should be repeated every 12 -18 months, depending on how long the patient can enjoy the results. Further treatments usually require less product as the increased amount of collagen in the skin strengthens its structure and helps it look younger. Such treatments are usually called “maintenance therapy”.
Contraindications include
How do I look just after the treatment?
After the treatment you should expect the area to be a little swollen, red and tender which is caused by the filler and swelling. Puncture sites are still visible these but will disappear soon. Shortly after the treatment hematoma and bruising may occur but these usually disappear within a few days. Bruising sometimes takes a couple of days to develop and 10-14 days to change colour and resolve with no further damage to the final result.
Before the treatment
There is no need for any preliminary medical preparation, but patients have to be in good physical condition. One week before the treatment patients should not take aspirin or any other medication that decrease blood coagulability. We advise our patients to take aescin (Aescin 3x2tabl, Reparil 3x2 tabl), a few days before the treatment as it decreases the risk of hematoma. Patients who tend to suffer from herpes should prophylactically take acyclovir (Heviran tablets 400 mg twice a day) two days before the treatment.
After the treatment
After the treatment you should apply a thin film of soothing gel and massage the area twice a day (use: Cicalfat, Cetaphil MD, Cicaplast Baume B5, Sensicure). If bruising occurs, it can be treated with Auriderm, Ortholan Vein, Lioton 1000 or Reparil. Patients are also advised to continue taking Aescin or Reparil.
Finally, when redness, tenderness, hardening and bruises clear up, patients can discontinue medication and resume their usual skin care practices. It is recommended that patients use high quality skin care products with sun filter SPF50+.
How can I keep the result for longer?
At Ekoderm we believe the aftercare is just as important as the treatment itself which is why we advise patients to look after their skin properly on a daily basis. You can do it by using a high factor sun protection that will protect against both UVA and UVB radiation (SPF 30-50+), as well as products which contain antioxidants such as vitamin C, vitamin E, ferulic acid or flavonoid. We also advise our patients to take diet supplements which contain vitamin C, vitamin E, coenzyme Q10 and flvonoid. It is important to refrain from smoking which is responsible for accelerating ageing processes and greatly diminishes all results of aesthetic treatments which have been achieved so far. The whole range of skin rejuvenating treatments such as medical skin peels and mezotherapy are also highly recommended.
Recommended supplementary treatments
We recommend that our patients who have been given treatment with hyaluronic acid should follow skin rejuvenating therapy. This will help to stimulate skin for better production of collagen. The therapy includes a series of medical skin peels (medical skin peel for the eyes Argipeel or Mandelac T) or products rich in multiple ingredients (NCTF HA, NEWEST, UP GRADE). Peels and mezotherapy should be repeated a few times every 2 to 4 weeks. Another therapy we recommend is an intensive regenerating treatment REGENERIS.
Patients who are planning the treatment should also consider resurfacing performed with the use of a fractional laser Palomar StarLux500 Lux 1540 or photorejuvenating treatment with laser handpiece MagG.
Who can perform treatments?
At Ekoderm all treatments are performed by experienced doctors trained in aesthetic medicine who have been given appropriate certificates.
