It would be extremely unsafe to shave down your cheek bones so your face is less wide. There are many crucial nerves that would be in danger in that area. If you have hollow temples the safest thing would be to fill in your temples. This will bring your cheeks into greater balance and your cheeks will not appear to be as wide.

The easiest way to add volume to the temples is with filler. Juvederm can be used to fill the temples in quickly and easily with minimal downtime or bruising. Sculptra can also be used in the temple but tends to take months and months to show a noticeable difference. Fat injections can also be used in the temples but are only cost effective if a large amount of volume is needed for the entire face.

The word "facelift" has been used generically to describe a number of procedures that have the goal of improving the appearance of the face. The term "liquid facelift" has been used to describe improving the appearance of the face via fillers or sometimes fat. Same goes for the term "non surgical facelift." SOmetimes the term facelift has been used to describe an overall facial rejuvenation which might include a classic rhytidectomy (technical word for a facelift) as well as a browlift, eyelid surgery, and neck tightening (platysmal plication). A "mini facelift" is not a technical procedure but a coined term that could describe any number of procedures from a non aggressive rhytidectomy to a neck tightening procedure. Needless to say, there is no uniformity in the terminology used for these procedures. What one surgeon might call a facelift, another might call a necklift, and another might call a mini-facelift.

The lack of uniformity in the terminology can lead to confusion when patients try to compare apples to apples and know what different surgeon's plans might be for them.

In my practice a facelift is a rhytidectomy that treats the jowls and neckline. It can sometimes be combined with a platysmal plication (further neck tightening, called a necklift by some) which is done via a small incision under the chin. A facelift doesn not help the brows or eyes--that's a separate procedure. A facelift does not raise the cheeks significantly--that's a cheeklift or midface lift.

Some surgeons call a facelift a necklift, maybe because it sounds more benign and less threatening, or maybe because they want to make sure the patient does not think it will "lift" the entire face--it only treats the jowls and sagging neck. A patient is a good candidate for a facelift if they have significant jowling and sagging of the neck while still having good skin elasticity.

A Y lift is a trademarked name for placing filler in the face to restore a more youthful facial shape and contour. The concept has been around for years, but the term "Y lift" was trademarked by a dentist in New York a few years ago. Basically filler is placed around the midface, eyes, and chin and jaw area to recreate the shape of the face when it was younger. The theory goes that a youthful face is shaped more like the letter Y and as we age we lose the lateral volume of the upper face which makes our faces seem more droopy. The only thing I find problematic about this is that it promotes a cookie cutter approach to facial fillers and volumization. I believe that for patients who naturally have very high cheek bones a Y lift will only make them appear more gaunt and older looking. A personalized approach is needed for every patient.

Patients need to take the time to do their research. The media loves catchy "new" procedures; it is easy for them to report on and it gets good ratings. Remember that just because something is on television does not make it the "best" thing out there, it just might mean someone has the "best" PR person out there. Sometimes a "new" procedure is just rebranding or trademarking a term for something that has been around for years. Plastic surgery is an investment. Just like with any other investment, the more informed you are about the process, options, and expected results, the smarter you will be and hopefully make the best investment decision.

Thinner people with high cheek bones age with their cheeks looking more and more obvious in proportion to the rest of their face. When you are young there is more facial fat and padding around the cheek bones, in the temple, and in the submallar area (area below your cheek bone). As we age we slowly lose the fat and padding in our face: our temple become more hollow, we lose fat under our cheek bone, and our skin becomes thinner. Imagine having a rock under a thick comforter... It is difficult to see the edges of the rock under there. As we age that thick comforter turns to a thinner sheet and now all of a sudden you can see the outline of the rock. That is sort of what the cheek bone is like in people who have high cheek bones. this does not happen in people who's cheeks are mostly composed of fat. Those people end up with flatter cheeks as they age.

The treatment for you is not to shave down your cheek bones, which would be dangerous. The treatment is to add volume around the cheek bone--add padding like a thicker comforter. Your temple can be filled out as can the area below your cheekbone. This will soften your look and make your face more like it used to be when you were younger.

Notice how this patient's natural cheeks seemed large and artificial before. Fillers where used to soften the look of her cheeks.

To learn more about facial fillers go to our liquid facelift and facial filler information page

By Gal Aharonov

Artefill is a filler that is effectively permanent due to the fact that the body cannot degrade it. It is composed of tiny microspheres in a suspension of bovine collagen. The collagen gets degraded over time but the microspheres remain and induce an inflammatory response by the body which deposits new collagen around it.

Because the results of Artefill depend on each individual's response to it, there is a certain amount of unpredictability. It is therefore prudent to initially under correct with artefill and use it in stages until the desired outcome is achieved.

Like most of the other fillers, Artefill is only FDA approved for injection into the nasolabial folds. Like all the other fillers, practitioners can use it in off label ways and inject it anywhere else they deem to be safe. That is where different doctors might have varying viewpoints as to where it is safe to inject.

The only places I would inject Artefill are in the nasolabial folds, bridge of the nose, high cheek bone area, and prejawl sulcus. All these places are conducive to deep injections on or close to the bone. The deeper the material is injected the less likely it is to cause troublesome lumps or other issues.

Because Artefill contains bovine collagen, a skin test is needed about a month prior to administration of Artefill to make sure you do not have an allergy to it. This is done for free in our office.

By Dr. Gal Aharonov

I get many patients coming in for consultation desiring a facelift because they feel it is a permanent fix while fillers or volumization is a waste of money. Some have even gotten upset at me for trying to talk them out of having a facelift and refusing to perform a facelift on them.

On the flip side, I have had patients coming in for non surgical treatments with fillers who I have had to tell them that their issues are best addressed with surgery.

A facelift addresses a completely different issue than volumization with fillers!

I personally believe that a facelift should be reserved for patients with significant neck laxity, jowling, and sagging. It does not address hollowness and volume loss! I feel very strongly about this and will refuse to perform a facelift on someone if it will not address their issues.

The only way to naturally address a face that has lost a lot of volume is by adding volume back! This can be done with fillers, fat injections, or sometimes facial implants. A facelift does not address volume loss.

The reason some people look like they have had plastic surgery is because they were not treated in the best way for their face. Many doctors succumb to patient pressure or desires and will perform surgery that is not right for that patient. Some doctors are also greedy at times and will push patients to have unnecessary surgery.

Please understand that I am a surgeon and would love to operate on someone if it will help them. But I will not succumb to patient pressure when I feel strongly that it will not benefit them. That sometimes makes patients upset.

Hollowing of our facial features is a main contributor to looking older and more tired. This could happen due to weight loss, genetics, having a very low body fat composition, or certain diseases. There are several good options for someone with your issue:

Fillers: Fillers can be used to target the hollowing features. They can be directly injected and you see an immediate result. This group includes injectables like Restylane, Juvederm, and Perlane.

Collagen Stimulators: These include Sculptra and Radiesse. Sculptra is an injectable but is not a filler. It causes your body to build collagen in reaction to it. It slowly works over several weeks and has a very gradual effect. It is usually done gradually over 2 to 3 treatment sessions to achieve an optimal result. Radiesse is a hybrid between fillers and Sculptra. It has an immediate filling component which you will see right away, and a collagen stimulatory effect that is also gradual like Sculptra.

Fat Injections: Fat can be harvested from other parts of your body, purified, and then gently injected back into your face. This is closer to being a surgical procedure but can also be done with you awake in our treatment room.

Using filler in the cheeks is one of the most common uses for fillers. The problem is that even though the cheeks themselves might look good after the injections--and that's a big if-- your new cheeks might be out of balance and out of harmony with the rest of your face. For example, a person who has volume loss in the cheeks and thinks they need bigger cheeks has most likely lost volume in the temples, under eyes, and right below the cheek as well. If these issues are not corrected at the same time, your new cheeks will look out of proportion to the rest of your face and might look fake.

The key to using fillers, or fat, or any other facial cosmetic surgery is to achieve facial harmony and balance.

So what are your options? Well, if you truly just want your cheeks to go back to what they used to, you can maybe have the filler dissolved, as long as a hyaluronic acid based filler was used (like juvederm, restylane, perlane). Your other option is to fill in those other areas a bit to bring your face into greater balance and harmony. Just a little filler in your temple, or under eye area might all of a sudden make your face look great and balanced again.

As we age we loose facial volume and fat in a nonuniform manner. Our cheeks loose volume as well as the area around our eye, temples, and jaw line. This contributes greatly to the aging process. When you were younger you probably had decent facial volume which blended better with the cheek implants. Since you are now loosing more volume around the cheeks, such as in your temples, under eyes, and lower cheek and jawline area, it makes the cheek implants appear more obvious and fake.

You have a couple of choices: one would be to enhance your facial volume around the cheek area, including your temples, under eye area, and brows. This will put your face into greater balance and harmony again.

Your other option is to take out the cheek implants, but then you will be faced with more hollowness and a more aged appearance. Your cheeks will no longer look fake, but instead might look deflated and older. At that point you can decide whether you want to enhance your facial volume. Your choices for doing that include fillers such as Radiesse, Restylane, and Juvederm, or your own fat.

I am personally not a huge fan of buccal fat excision. I will perform it in very rare circumstances. Why? Well, it is a very easy straight-forward procedure that takes less than 10 minutes to perform. The problem is that patients who get this procedure done might look better right away, but as they age their cheeks become hollow and gaunt--in my opinion they look horrible.

The face needs to be approached as a holistic entity where balance between all your attributes is the goal. Most people who think they have big chubby cheeks in reality might just have relatively smaller cheek bones compared to their lower cheeks. Or a relatively smaller jaw. It is possible to make your face look more attractive and harmonious by enhancing some of your other features, as opposed to excising fat. This approach will make your face more attractive for years to come, not just for the next year or two.

I have many patients who have come to me for buccal fat excision and instead we used a small amount of filler in the upper cheek area. This gave them the appearance of having smaller cheeks while making them more attractive with more defined cheek bones. It also made them look like they lost weight, even though their cheeks stayed exactly the same! You have to see it to believe it!

In summary, as easy as buccal fat excision is to perform, I would rather do what's right for the patient's long term benefits.