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Illuminance from Singapore asked a question

What are some effective methods to get rid of fat cheeks that are sagging? (photos)

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DxD

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Dr Kellyn Shiau
(7 Reviews)
12 answers on DxD

Dr David Ng C H
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20 answers on DxD

Dr Por Yong Chen
(2 Reviews)
6 answers on DxD

I am a 26 year old ex-smoker, thus now have loss of collagen in my face. I noticed my cheeks have sagged and made my lower face look even fatter, as before this it was already fat. My concern is now when I smile, I feel like my facial muscles are unable to support the sagging fat, thus I feel some ache around the nasolabial folds when smiling. I’m not sure if I should do ultherapy to get rid of the fats, buccal cheek fat removal, or mesofat injections. Ideally I'm looking at buccal cheek fat removal and meso as I want faster results without having to repeat the procedure. May I get some opinions/thoughts?

DOCTOR’S ANSWER (5)

Dear Illuminance, first of all, rest assured that many other ladies identify with you, thanks to the multitude of "v-shape" face advertisements.

Your face is like a ‘layered cake’. Simplified from outside to inside, the layers are:

  • Skin 
  • Fat (we doctors call it subcutaneous tissue) 
  • Fascia or SMAS ( tough fibrous tissue layer) 
  • Muscles and then Bone ... i.e your skull  

Smoking destroys the elastin part of the skin. The skin tissue matrix has many components, not just collagen. 

Collagen may deplete faster than can be replaced by fibroblasts (cells that can make collagen, you can’t eat it to replenish collagen, unlike what 'collagen hot pots' would have you believe it).

The fibrous layer can also sag. When that happens, your mid-face cheek fat compartments which were previously held in place will now start to drop! 

So my question to you is, at just 26 years of age, would you like to ‘whip out’ that ‘fallen’ fat ? Remember, fat tissue volume is what stops us from looking like emaciated ‘skull faces’. 

If you have seen chronically ill patients, they look very hollow because they have depleted facial fat, and hence volume. So now, I guess you may have thrown the idea of ‘melting’ your fat tissue with meso therapy out of the window. (By the way, MOH in Singapore does not allow the provision of meso therapy).

You mentioned one of the many HIFU (High Intensity Focused Ultrasound) machines available. Ultherapy is just one of them. In Singapore alone, there is: 

  • Indigo
  • Doblo
  • Ultrafomer 
  • Ultherapy 
  • SygmaLIFT (Switzerland)

Yes, Ultherapy is just a type of HIFU treatment. This information has surprised many patients. HIFU is a technology, not a brand. So it’s really funny for me to read that one is better than the other. 

Now, let’s not be biased with brands and use the generic acronym HIFU. HIFU can indeed be used to tighten the skin. This is like firming up the ‘corset’ of your face. 

It can only do so much I’m afraid, but don’t discount it’s importance. 

Can HIFU be adjusted deep enough to contract fat tissue? Yes it can indeed, but is this really what we should do in your situation? Maybe only in certain areas. Your fat, (and this seems counterintuitive), is precious ! 

Now let’s see if we can firm up deeper fascia layers that also hold your facial compartments up. 

Short of a face lift, we can now address this layer at the hair line area. The dermatologists in Korea, (South, not North), have adopted the Enerjet from the USA into an updated version called the AirJet. 

This is a needleless (yes, no needles!), drug -delivery device. Instead, it uses a concentrated glucose solution to infiltrate the fibrous tissue layers at the hair line, which have been suggested to have connections with the fibrous tissue layers down the face. 

The glucose solution is safe, and can effectively stimulate collagen production and tightening. 

This tug of war battle strangely pulls up sagging fibrous layers! With firmer skin, fibrous layers tightened, and judicious redistribution of precious fatty tissue, patients will be able to regain their V shaped proportions. 

If the sagging is very severe, a little help from a threadlift with hooks can help stubborn areas. 

In short, there are multiple causative factors for sagging skin - balancing your treatment options will put you in a better position to solve the problem.

Finally, to reiterate, fat is precious - if you remove it without much thought about the future, you may find yourself asking for a fat transfer or multiple fillers to get the volume and proportions back in future. 

Do find yourself a good doctor to have a discussion with, and I wish you all the best in your quest in restoring your facial proportions. Also, try to quit smoking too!

0 934 views 0 Doctors agree Mon Mar 05 2018 07:54:29 GMT+0000 (UTC)

Dear Illuminance, thank you for your question!

Congratulations on quitting smoking - that's the first and cheapest step to a more youthful appearance and better skin.

It can be difficult to give suggestions to you based on pictures without a complete clinical evaluation in person. The previous replies by all the doctors have lots of valuable information within and have touched on the various non-surgical treatments available for you, notably for skin firming/lifting purposes.

My personal opinion is that it depends on the look you are trying to achieve on your face. Fat is important on the face, but equally important is the amount of fat, and where this fat is located.

As Asians, we often have broad, underprojected faces with a heavy lower face and a short chin. As we age, we will experience volume loss of fat, muscle and bone, and consequently also experience descent of the skin or sagging due to deflation. 

Whilst, fat preservation in certain areas of the face is crucial to reduce the effects of this, it is also difficult to expect someone to live with a round, chubby face in anticipation of this. Therefore, it is vital to have a detailed consultation with someone experienced in this, prior to embarking on any surgery to the face.

To answer your question on the surgical options (as the non-surgical ones have already been expounded on), the treatment of the heavy, saggy, chubby lower face are - limited buccal fat removal combined with a skin firming/lifting procedure, and facial liposuction.

The choice of either depends again on the clinical assessment of your face in person and the look you are trying to achieve.

Best Regards

Dr Samuel Ho 

0 923 views 0 Doctors agree Mon Mar 05 2018 09:29:18 GMT+0000 (UTC)

Hi Illuminance,

From your photos, I do not see significant cheek sagging or even significant cheek fat. I would discuss carefully with your trusted doctor before proceeding with any procedure rashly.
 

I would like to remind you that mesofat injections are disallowed in Singapore currently, so you may wish to consider other options if you really think you have fat cheeks. 

There is a Q&A on DxD that gives the various options for achieving a slimmer and lifted face appearance. Do check it out!

Regards,

0 959 views 0 Doctors agree Sun Mar 04 2018 17:32:48 GMT+0000 (UTC)

Dear Illuminance,

Thank you for your question and photos.

I agree with Dr Chua. In addition to what he has mentioned on mesofat injections and buccal cheek fat removal, I would like to share some information on Ultherapy. 

Ultherapy cannot remove fats. As a HIFU technology, it helps with skin tightening and lifting.

Common treatment areas include cheeks and jawline.

For a non-invasive treatment, the results are pretty long-lasting - 9 months to 1 year.

Hope that this helps!

Regards,

Dr Justin Boey

0 948 views 0 Doctors agree Mon Mar 05 2018 01:13:04 GMT+0000 (UTC)

Hello Illuminance

Thank you for your question. In addition to what everyone has said, you can also consider using fillers to lift the face to produce a slimmer and more V appearance.

This is known as the liquid face lift. The effect can last for 1 year or more depending on the type of fillers used. All the best! 

Regards

0 849 views 0 Doctors agree Mon Mar 12 2018 12:14:09 GMT+0000 (UTC)
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