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‘Minimal-Invasive’ Does Not Mean ‘Minimally-Trained’

Posted: 12:01 a.m. Sunday, Nov. 4, 2018

By Anita Mandal, M.D.
Question: I had filler injected over the sides of my cheeks bones. My cheekbones look wider and higher, but the cheek part underneath is more sunken-in and my eyes look more narrow. Even the hollows under my eyes seem more pronounced. Why does the rest of my face look worse when my actual cheek bones look better?

Answer: Your concerns are not unusual if your injector did not carefully evaluate the areas surrounding your cheekbones. Patients often come to my office seeking a secondary consultation after another injector overtreated one facial area, leaving the surrounding untreated areas out of balance.

An increasing number of less qualified doctors are entering the cosmetic injectables business. Not only are complications from injectable fillers on the rise, but unnatural and incomplete results are also more prevalent. It’s becoming more and more important to verify your injector’s credentials.

Unlike a Restylane Silk treatment for superficial lip lines, facial volumization of the cheeks, temples and deep smile lines is most suitably achieved with deeper injectable fillers such as Juvederm Voluma, Sculptra and Bellafill – the 5-year filler. With facial volumization becoming part of mainstream cosmetic surgery, injections are being placed deeper within the facial tissues where important nerves and blood vessels sit. Greater understanding of the deeper facial anatomy is needed to avoid problems and produce optimal results.

The same deep tissue planes that only surgeons were once trained to enter can now also be injected non-surgically by an inexperienced doctor or, in some states, a non- doctor, because injectable filler treatments are not regulated as strictly as surgery.

In your case, I suspect that your injector overfocused on creating a higher cheekbone without considering how treating an isolated concern would affect the balance and proportion of the surrounding areas. If you had lower lid hollows that were left untreated, they could now look worse. If you had some volume loss under your cheekbones, then making your cheekbones fuller and wider could make the lower cheek appear more hollow and your eyes seem more narrow.

In most cases such as yours, your facial balance can be restored by volumizing the untreated surrounding areas, although I’d have to see you in consultation to make a final determination as to the most suitable approach.

It is important for the public to understand that minimal- invasive does not equate to minimally-trained. Careful consultation with a Board Certified Facial Plastic Surgeon who understands the complex facial anatomy is the first step in optimizing your facial rejuvenation results.


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