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Check Enhancement

As the name suggests cheek enhancement or augmentation is to add volume or lift the cheeks by surgical (using fat graft, cheek implants) or non-surgical (using injectable fillers) means.

Techniques Of Cheek Enhancement:

1. Injectable Dermal And Soft Tissue Fillers:
These nonsurgical cosmetic treatments are more popular than surgical intervention. The technique is based on the surgical concepts and for maintenance and longevity of the results the strategy of injection, minimal downtime, and combination with other nonsurgical techniques is required.

The commercially available dermal fillers include:

  • Collagen-based fillers

  • Volume replacement fillers such as hyaluronic acid

  • Biostimulatory fillers such as calcium hydroxyapatite and poly-L-lactic acid.

1.1 Hyaluronic Acid–Based Fillers
For the temporary effect, the hyaluronic acid-based fillers are used. Their temporary effect is due to the higher rate of degradation, which is inversely proportional to the amount of crosslinking in the filler and amount of hyaluronidase formation in case of adverse events.

Indications for hyaluronic acid-based fillers include the zygomaticomalar area, anteromedial cheek, and both subcutaneous and supraperiosteal injection sites areas, the nasolabial fold and tear trough.

1.2 Coralline Calcium Hydroxyapatite
It is indicated in the augmentation of the facial skeleton over the anterior maxilla, zygoma, and mandibular body.

1.3 Poly-L-Lactic Acid
It is traditionally used in the treatment of human immunodeficiency virus (HIV)-mediated lipodystrophy, however, it has got traction in the cosmetic medicines. It is injected subcutaneously to augment skin creases like the nasolabial fold by stimulating fibroblasts to produce collagen.

1.4 Autologous Fat
For soft tissue filling autologous fats procured from the thighs or the anterior abdominal wall are used. It is used in the voluminization or contour problems in the nasolabial, nasojugal, malar, or submalar areas. It is injected either subcutaneously or preperiostealy. It also gives a temporary effect as 50% of the initial volume gets resorbed.

Complications Of Fillers:

  • Hyaluronic acid in high concentration given superficially leaves a bluish tint to the skin, the “Tyndall effect”.

  • If injected intravascularly can produces soft tissue necrosis, blindness, and stroke.

  • Other common complications include overfilling or underfilling, inappropriate tissue depth or location or filler, and infectious or allergic complications.

Complications created after use of hyaluronic acid–based filler can be resolved partly with hyaluronidase.

2. Implants
The most common types of implants are:

  • Silicone

  • Porous polyethylene

The procedure is performed under either local anesthesia, intravenous sedation or general anesthesia. The choice mainly depends upon the surgeon’s preference. Based on the type of material different sizes of incisions are required. Commonly, the incision of few millimeters in length is required. The site of incision is also a surgeon’s choice. Some prefer cheek implant through incision inside mouth while others prefer through incision under eyelids. The solid cheek implants gives permanent effect.

2.1 Silicone Implants
These are more advantageous than others. The advantages include customizability due to simple cutting procedure with a scissor or a blade, easy removal, and higher flexibility that allows placement through a smaller incision.

2.2 Porous Polyethylene Implants
The advantages of porous polyethylene implants include permanent effect due to soft tissue integration, customizability.

Complications Of Implants:

  • Infection and/or extrusion of the implant

  • Hematoma and/or persistent swelling

  • Deformation of the overlying soft tissues due to encapsulation of the implants

  • Malpositioning despite of screw fixation

For resolving most of the complications the implant is required to be removed.

Other Techniques Of Cheek Enhancement:

  • Rhytidectomy: Used as an adjunct with other techniques to treat skin excess

  • Osteotomy

Undereye Hollowness

What Is Undereye Hollowness?

The medical term for sunken eyes is “tear trough hollows”, wherein the delicate skin under the eyes appear dark, sunken, and hollow. Sunken eyes can be prevalent in older adults. Mostly, sunken eyes are not related to life-threatening conditions. If the condition worsens over time despite attempts to get better sleep and drink enough water, or if they are accompanied by other symptoms, you should visit a doctor.

What Triggers It?
In most cases, sunken eyes relate to the quality of nutrition and the health status of an individual.

Some health and lifestyle issues affecting the under eye skin under the eyes are as follows:

  • Dehydration Or Reduced Water Content In The Body: most common cause of sunken eyes

  • Nutrient Deficiencies: deficiencies of vitamin C and K and/or iron

  • Sleep: inadequate sleep or poor-quality sleep

  • Aging: collagen loss with aging might cause sunken eyes

  • Weight Loss: can cause under eye blood vessels to become prominent, skin to be transparent, and nutritional deficiencies

  • Genetics

  • Smoking: can cause collagen and skin elasticity degradation, leading to sagging of facial skin, and the eyes to appear sunken

  • Allergies: can cause the eyes to sink, which can be attributed to inflammation in the tiny blood vessels below the eyes or blocked nasal passages

  • Sinusitis: inflamed sinuses and nasal congestion and pressure can cause sunken eyes

  • Trauma: injury to the area can cause sunken eyes

  • Sun Exposure: can make the skin darker, which can cause the appearance of hollowed-out eyes owing to darkened circles

  • Allergies: Allergic rhinitis or hay fever or seasonal allergies can cause sunken eyes

What Are The Symptoms?
Sunken eyes are often described as:

  1. hollowing under the eyes

  2. dark shadow over the lower eyelid

  3. dark circles underneath the eyes

  4. thin-looking skin under the eyes

  5. overall tired or fatigued look in the face

How Is It Diagnosed?
Medical history, followed by visual inspection of the face is the usual routine. The doctor needs to know about any other physical or emotional symptoms, if present, such as nasal congestion, itchy eyes, fatigue, or weight loss, or if the condition is affecting their self-esteem or causing depression and anxiety. Laboratory tests might follow.

How Is It Treated?
Sunken eyes resulting from medical conditions can be treated with medications, including prescription antibiotics for sinus infections and over-the-counter antihistamines and eye drops for allergies. Dermal fillers such as Juvederm, Restylane, and Perlane involve an injection of a naturally-occurring substance known as hyaluronic acid into the sensitive tissue just below the eye. A filler is usually painless and takes a few minutes to inject, but it does not last forever, and will require repeat procedure. Both major and minor surgical treatments are available for people who experience sunken eyes due to aging. Cosmetic surgery, including brow-lifts, blepharoplasty (lower eyelid surgery), and face-lifts can reduce the appearance of sunken eyes. These techniques are more invasive than dermal fillers and involve a longer recovery time. However, they can offer a more long-term solution to sunken eyes. However, surgery is never without risks; therefore, it is important to be well-informed before opting for surgery.

Lifestyle Changes And Home Remedies
Following can help ease sunken eyes: adequate good quality sleep; use of good-quality moisturizer with sunscreen and cold compresses; topical use of almond oil, fish oil, lemon juice, raw potatoes, cucumber, and warm and moist tea bags directly below the eyes; adequate consumption of water and dark green leafy vegetables; and avoidance of excess caffeine and smoking.

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