The cheek is a critical area of the face when one considers the effects of aging and damage to the skin. One of the clear signs of youth is a curved, full, convex cheek as one is used to seeing on babies in their first few years of life. With age the cheek tends to sag as a result of volume loss with fat, muscles, bone and teeth all diminishing or becoming lax. Sun-damaged skin does not necessarily spring back as it has lost its elasticity. These changes can have significant cosmetic effects, thereby affecting the confidence of a person.
One of the first changes one sees on the skin of the cheek is acne scarring. This often occurs in teenage years and there are many forms of scarring such as pits or gentle sloping scars.
People who are middle aged often develop sun damage on the cheeks due to the prominence of this area receiving sun exposure. This may present as broken blood vessels, areas of pigmentation or just generally mottled skin.
From middle age onwards, the cheeks can have significant changes that make a person look much older. In particular, there may be loss of volume of the cheeks. This occurs due to loss of fat, thinning of the collagen and elastin layer, or general diminution of the bony structures of the face. This loss of volume presents as a convex or hollow appearance which creates shadows and portrays an aged and old appearance.
Another change that occurs with the loss of volume in the cheeks is that the skin starts to sag and drape over the smaller facial structures. This is particularly seen on the lower part of the face where the jowl area may be square or actually drooping. Often the changes extend on to the neck with sagging of the skin is referred to as the “turkey neck”.
The appearance of the cheek can be improved by treating the area in which the changes have occurred. The aim is to rejuvenate the area through the use of agents that may address the ageing surface, loss of volume and redundancy (sagging) of the cheek. There are many non-surgical treatment options available.
- Skin surface
Fractional energy devices and needling may be used for acne scarring and photodynamic therapy for sun damage. For more severe changes, ablative erbium or CO2 laser may be required.
- Loss of volume
The loss of volume of the cheeks can be corrected in a number of ways. There are simple dermal fillers that dermatologists can use which involve injections that only take a few minutes. These procedures often last for 12 to18 months.
Another form of filler is using the person’s own fat. Fat is removed from areas of the body through a mini liposculpture and the fat may be cleansed and purified and then injected. Some dermatologists offer fat storage. Fat can also be concentrated with stem cells which may enhance survival of the fat. One of the concerns of fat transfer is that the longevity is variable; fat may last forever or may last for a few months and in some cases may totally disappear and require repeat treatments.
There are also other forms of cheek implants which are physical solid implants.
- Elevation of the loose skin
Elevation of loose skin may be performed both surgically and non-surgically.
Surgical elevation of the cheeks can be performed with sutures such as the skin suture lift where stitches are tied where the skin dermis is attached to the ear cartilage or the skin is tightened using small barbed wire threads.
Another form of lifting is face lift surgery. Face lift surgery falls into two types. There is a mini face lift where the skin is cut right around the ear and the elevation of skin is restricted to the area just in front and behind the ear. For individuals with severe drooping or those looking for a more dramatic effect, a deep plane face lift may be required.
This information has been written by Dr Greg Goodman
This page is currently under review.