Causes of Cheek Asymmetry and Hollowness in Young People, and How to Treat it Without Surgery


Thank you for your question. You submitted your question with a photo. And you’re asking, can you correct cheek
asymmetry or facial asymmetry non-surgically. And you describe further in the details of
your question a situation where you are well aware of asymmetry in your face since childhood. And that in the past two years, it has become
more noticeable for you and you want to know if there’s anything you can do. Well, I can certainly share with you how I
discuss very similar types of concern with patients who come to my practice every day. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long
Island for over 20 years. Helping people improve their facial appearance
from both genetic causes as well as age-related causes has been a significant part of my practice
and has continued to evolve as technologies and techniques have improved. So I think you certainly recognize what is
a situation that applies to pretty much everyone. And I always explain to my patients that our
facial appearance is actually guided mostly by our bone structure and the bone structure
is like the foundation of everything else. So when you look at yourself and notice one
side looking a little bit different than the other, it begins from that level. And so very typically, we would have a discussion
about just natural asymmetry and then discuss ways to improve symmetry. So to begin with, when it comes to cheek asymmetry,
a common strategy that I employ is to do something called Structural Volumizing and the logic
is basically this. When you look at ways to enhance facial appearance,
when it comes to volume correction, you can place what is generally used something called
fillers, fillers that are mostly in the hyaluronic acid family, for example such as Restylane
or Juvederm and all of the different respective filler families. You are either placing it at the skin level,
below the skin or in our case, we actually place it at the bone structural level and
this is actually a specific methodology that is not commonly practiced. The reason I do that is that I feel that when
you address volume at the foundation, you get a much more natural appearance. And so whether it’s someone who is young
who has a concern about asymmetry that is naturally part of their anatomy or someone
older who is losing volume from bone loss and soft tissue loss, Structural Volumizing
has become an invaluable tool in my approach to helping patients with these concerns. So to answer you question, is there a way
to make a correction non-surgically, the answer is yes. However, it is important to recognize that
there is a certain amount of maintenance needed when you start using fillers. And it’s not because you are dependent on
fillers. People often express concerns to me about
becoming dependent or they would look worse after not using fillers. And I explain that there’s a big distinction. When you are making up for a relative deficit,
whether it’s from genetics or aging, well you’re not really stretching anything. You are actually placing volume in a space
that gives you a certain amount of permission to add volume before going to that point where
things get very stretched. From my aesthetic, being stretched is never
an aesthetic goal. And so I always remind our patients is that
we’re doing something that I would refer to more as a correction which means a conservative
placement of a certain amount of volume to achieve a certain desired outcome. Now when you do place volume at the bone level,
I tend to use more volume than you would when you place the material superficially. So this is something that, as you are doing
your research, you should be comfortable with the doctor you decide to go with. I think it is very important to meet with
a doctor who can discuss this in detail for you, with you, and go over this strategic
understanding. I routinely see my patients after two weeks
to look at the level of improvement and it’s essentially a getting to know the patient
process that’s intrinsic to my developing a sense of feel as to what that patient needs
as the material eventually diminishes. Now when it comes to Structural Volumizing,
one of the nice things about this method is that you actually have the benefit of the
fillers actually lasting longer. Generally speaking, you can achieve a result
that can last over a year. And as the material breaks down, you don’t
necessarily go all the way back to where you started but I would say that there is an opportunity
to do some maintenance again depending on the rate on which the material breaks down. So meet with experienced physicians who perform
this type of procedure and learn about your options and come to an idea of what is a desirable
outcome that you would find satisfactory and then try this out. What’s really nice about using a filler
like hyaluronic acid filler is that when you use something like this, it’s of course
very safe and it is very easy to work with. It is also reversible. So if someone doesn’t like an outcome, they
can always have this material dissolved and that’s a huge advantage. Very rarely is that necessary but it is nice
to have that option in case you would need it. So I hope that was helpful, I wish you the
best of luck and thank you for your question.

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