Facial Aesthetics Using Botulinum Toxin and Dermal Fillers

Part 3 - Cheek enhancement

Instructors:

Bob Khanna, DDS

Bob Khanna, DDS

Professor Bob Khanna is a Cosmetic and Reconstructive Dental Surgeon. He runs successful clinics in Ascot and Reading and carries out a full spectrum of treatments from Aesthetic Dentistry, Surgical Implantology and bone regeneration procedures to full mouth rehabilitation.

Dr. Khanna demonstrates the use of dermal fillers for cheek enhancement

And now I'm going to promote augmentation on Kerrie's cheeks. In a very particular way as we saw from the photographs that she has a long but thin narrow face. And what I'm going to promote is an increase in width of her zygomatic arches to develop the contours in this important region, the so called ogee curves to promote therefore a more tapering form to her face which will feminize her very nicely. It's very important to ascertain where the projection is required in a patient's face. Now you can see with Carrie's case, she's got a thin but long rectangular shaped face. I'm going to try and promote a more of a heart shape. I think it would be beneficial to actually give you increase width or girth to the upper aspect of your mid face here. So what I'm going to do with that in mind is work out where I need to have the projection. Look at me. So what I like to do is draw the vortex of where that intended projection ought to be. And in that way I can maintain symmetry. I can look at the outer canthus of the eye, the brows and be very clear as to where that projection will reside. And now from there I'm going to draw a perimeter for proximately 2-cm in diameter. That's fine. That's lovely. Good. So now I'm going to place a little stab into region, place the cannula into the sub-dermal fat. And this cannula is very blunt. So it will navigate very nicely into the region as you can see. And because I've marked the vortex of the projection that's required, it becomes a lot more predictable as to where the product placement ought to be. I would advise everybody to do this marking whilst the patient is standing up. I'm just injecting into the zone very carefully. And then what you can do is start to fan out into certain areas just to rebuild this and contour the whole of the cheek. You see this cheek developing before your eyes. Any pain there? No. Because it's a cannula I'm allowed to move quite freely within that fat zone and develop a very nice contour. So I'm going to place my needle, create a little tunnel for myself and then just place my needle or my blunt cannula rather into the zone and then navigate very nicely through the fat. You see that little resistance but that's very important to experience that because I'm actually doing some blunt dissection into the fat and being able to essentially arrive at my destination which is very important. I can feel where I am and then I can very carefully just augment the zone very nicely and predictably. This is a layer of fat which is just above the orbicularis in this zone which often refer is the malar fat. But in many cases I may also want to choose to augment the sub-orbicularis oculi fat which is called the SOOF. And in that situation I would then promote more of an augmentation particularly if I overlay the sub-dermal fats. Let's have fun. We take the cannula out. That's fine. Good. Done. Let's have a look. And now my favorite part, massaging the cheeks. So this is a very mild augmentation of the cheeks just to promote a little bit of a healthy increase in width. And we can always add a lot more to this area depending on the patient's request. This is a nice start point. I placed about a mil of product, so a mil of very viscous hyaluronic acid. In this case, this is Restylane SubQ. They're very carefully developed for the cheeks and chin. So today we saw a number of procedures being preformed. We saw masseters being injected with botulin toxin because of hypertrophy, we also saw some lips being developed, the vermillion borders being defined, the so-called smokers lines or the perioral lines being alleviated and rejuvenated using hyaluronic acid very carefully positioned in the borders. We also saw some botulism toxin being placed in the forehead in the perioccular region to promote not only a wrinkle free softening zone but also an alleviation of the underlying asymmetry that was there and a reduction in the glabellar fold. We also saw finally how we can augment a very important region, certainly on a female's face which is of course the cheeks. And by increasing the width and the voluptuous nature of the cheeks, we instantly feminize a female's face. Very, very needy in a lady like Kerrie who has a very long, thin rectangular base to her face.