In order to answer this question , a consultation and evaluation of the actual cause of the saggy cheeks must be done first .
The common causes would be loss of skin elasticity and collagen , loss of facial volume due to facial fat pads deflation , migration of fat pads downwards or increase in fat and ligament laxity ( especially the mandibular retaining ligament ) . Of course these causes could also coexist to a certain extent.
Treatment options should then be directed to the underlying causes.
1. Loss of skin elasticity and collagen — use of energy and light based devices . These include the monopolar RF devices like Thermage , Exilis Elite , HIFU devices like Ulthera, Ultraformer III and to a lesser extent lasers for collagen remodeling like Laser Genesis or the newer Picosecond lasers . We can also used Threadlifts to reposition the sagging skin using either the Korean PDO threads or the Silhouette threads with cones.
2. Loss of facial volume due to deflation of facial fat pads—- replacement of the fat loss through use of dermal fillers or fat grafting . Fillers of appropriate viscoelastity to replace volume and create a Lift can be injected in a subcutaneous or deep plane to corrrct the saggy cheeks
3. Heaviness of the lower lateral cheeks due to fat volume increase or increase of buccal fat can be addressed by use of HIFU devices to reduce the subcutaneous fat or as in the case of buccal fat through surgical buccal fat removal.
4. Combination of the above plus laxity of the retaining ligaments like mandibular , buccal maxillary and to some extent the zygomatic ligaments . These ligaments laxity can be corrected using the True Lift technique through the use of filler gel ( Restylane Lyft ) with high lifting capacity .
Hope this helps .
Regards
Dr KK Chew
