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Cheeks

Cheeks, given their location on the central face and contribution to facial expression, are a key target in any facial rejuvenation plan.   There are several changes of facial aging and sun damage that occur on the cheeks, which makes this one of the most common areas identified by patients as problem areas.

Read Dr. Cohen’s contribution to the New York times article, New Beauty Goal: Plumper Cheeks

Common changes and patient concerns encountered on the cheeks at AboutSkin Dermatology:

Volume loss.  One of the earliest changes I notice on my patients in their late 30’s and early 40’s is flattening of the mid-cheek and hollowing of the tear trough area below the eyes.  Over time this flattening and deflation of the cheeks is accentuated by loss of fat and supportive bone structure as well as decreased skin elasticity.

Solution:

  • Fillers (Restylane, Lyft, Voluma, Radiesse) for immediate cheek re-inflation and improved round contour and for correction of hollowed tear trough leading to decreased shadowing and “tired” appearance. (1+ years duration)

    Filler for Cheeks
    Restylane filler at tear troughs and cheeks
  • Sculptra for gradual, natural collagen building and volumization over 2-3 injection sessions. (2+ years duration)
  • Skin tightening procedure (SkinTyte, Infini RF, Ulthera) to improve outer skin envelope, which can improve overall effect of fillers.

Skin Texture Irregularities.  Fine lines, crepe-like wrinkling, and acne scarring common findings on the cheeks. 

Solution:

  • Laser Skin Resurfacing (non ablative, fractional ablative, fully ablative, Hybrid fractional ablative) is the most effective way to correct textural irregularities and scarring.  Depending on the laser procedure chosen, usually patients require a series of treatments for optimal results with recovery downtime ranging from 3 days up to 2 weeks.

    Fully ablative laser resurfacing to full face
  • Infini RF (microneedling with radiofrequency) is a minimal downtime procedure for superficial skin tightening and acne scarring.  Patients notice the best results after a series of 3-4 treatments.
  • Chemical peels, especially those at medium depth using TCA, are an economical way to approach fine lines and wrinkles.  Lighter peels can leave the skin feeling temporarily smoother and brighter.

Redness and vessels.  Red broken blood vessels on the face, often most visible on the cheeks and areas around the nose, are a common feature of sun damage and rosacea.  While rigorous sun protection and rosacea treatment can help in preventing new red areas, the only way to get rid of them is with laser treatment.

Solution:

  • Pulsed Dye Laser (PDL) targets the blood within the vessel, creating heat and damage to the vessel wall, which eventually shrinks and disappears.

    cheeks-telangiectases-pdl
    Pulsed dye laser (PDL) to cheek vessels

Brown spots.  Sun spots (freckles), melasma (“mask of pregnancy”) and benign macular keratoses are frequently seen on the cheeks where the sunlight exposure can be more intense.   Long-term prevention with consistent sun protection, retinoid, and topical antioxidants is essential.  Lightening creams like hydroquinone are helpful but work best in combination with one of the following procedures.

Solutions:

  • Intense Pulsed Light (IPL) in a series of 2-3 treatments can dramatically reduce sun spots.

    cheeks-brown-spots-ipl
    Intense Pulsed Light (IPL) to sun spots and freckles
  • Spectra Nd:Yag laser is useful for melasma, stubborn isolated brown spots, and pigmentation due to acne.
  • Microlaser peel allows finely controlled resurfacing to a defined depth in the skin.
  • Chemical peels are often used to even out skin tone on cheeks.