Alexander Rivkin, MD
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Alexander Rivkin, MD
Plastic surgeon | Views: 243898

Friendname: AlexanderRivkinM.D.
Business Name: Westside Aesthetics
Website: www.westsideaesthetics.com
Location: 1033 Gayley Ave #104
los angeles, CA 90024
United States
Telephone: 310 443 5273
Languages Spoken: English

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Ask An Expert > Alexander Rivkin Message Board > Should I revise my cheek implants or use fillers/fat transfer to address assymetry?
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El Cajon, CA
Should I revise my cheek implants or use fillers/fat transfer to address assymetry?
I'm addressing this question to plastic surgeons who have experience with facial implants. I had cheek implants surgery about 10 years ago. They were inserted through my mouth. They have been assymetrical ever since, the left one is slightly higher and points downward and the right one is more lateral. My face was fairly flat before so the implants do provide me some volume which I need. I am in my early thirties and as I age the assymetry bothers me more as I can notice it in my smile etc. The implants are hard silicone I think goretex (?). Also I have lost volume under my eyes (eye hollows) and think that I would need to address that with fillers or fat. I am weary of revising because of the possibility of scar tissue, surgery recovery time, complications, and think that fillers or fat might help rather than having an invasive surgery. I have seen a few facial plastics surgeons, one advised just to leave them alone, the other advised taking them out and using fat instead or replacing at a later date, and the other recommended adding fillers to address the issue. What is the best way to address this and are new ways/methods emerging that would address facial hollowness? How long would recovery be for the options? Please help, I need an expert who understands facial plastic surgery.
Thank you so much.

Plastic surgeon
Beverly Hills, CA
United States
View My Professional Profile
Cheek implant asymmetry  May 10, 2010 9:50 AM

Cheek implant asymmetry is a very complex issue. The cheeks and eye sockets and globe (eyeball) are always asymmetrical. It takes an artist's eye to assess how that asymmetry can be minimized without creating any additional problems.

For example, if one eye is deeper set, then making the cheeks exactly the same will create one deeper, odd appearing eye. So in that case the asymmetry is actually necessary... to some extent.

We often use LiveFill(TM), untraumatized fascial fat grafts, to help asymmetry issues or to soften existing cheek implants.

More often than not, patients decide to have their old implants out altogether when they learn about LiveFill(TM), and to replace the implants with their own tissue.

Brent Moelleken MD FACS
Associate Clinical Professor, UCLA
Private Practice, Beverly Hills, CA

Plastic surgeon
New York, NY
United States
View My Professional Profile
  May 10, 2010 5:00 PM

After having performed thousands of fat transfer procedures, I can tell you that nothing beats a great transfer. Don't remove your implants, just have the fat placed over it. This procedure is very safe in the right hands. Assymetry is normal, with 90% of the population having a more slanted and higher left eye position.

Plastic surgeon
los angeles, CA
United States
View My Professional Profile
I would suggest using Juvederm or Radiesse  May 10, 2010 5:20 PM

Dr. Moelleken is right on the money - cheek implant asymmetry can be a complex issue and it takes artistic ability to restore 3 dimensional symmetry to the area.
I would suggest a slightly different approach, however. Addressing the eye hollow issue requires fillers or fat, so we are already doing that. I think it would make sense to try to address the cheek area the same way.
Between fillers or fat, I prefer fillers. Fat still has issues with reliability and its a surgical procedure. It is also not reversible. Fillers are non surgical and take 10 minutes to administer. When we inject fillers, we know how long they are going to last and we do not have to overcorrect. Also, juvederm is reversible - if there are bumps or asymmetries, it is a snap to correct them with enzyme injection.
Although Juvederm in most areas lasts 7 to 9 months or so, under the eyes it lasts for 4 years or more.
It seems logical to try fillers first.

Consult with Dr. Terino for your cheek implants  May 10, 2010 7:59 PM

Thing is the plastic surgeon with the MOST experience with (silicone) cheek implants, is not on this board. So the answers you will be getting will resolve to what ever each PS who answers you, does.

With regard to cheek implants, they can be removed (assuming you have silicone) and replaced. You never know, maybe the asymmetry you have is from a shifted implant. It's possible to get a CT scan to get skull model of your face and design custom implants from there. It's a lot 'extra' though--maybe over 8 grand extra.

Dr. Terino has an implant out (which by the way, I had been 'hounding' him to get it out years ago and he finally did) which also addresses suborbital volume loss and the cheek implant covers a large part of the face--not just one part of the malar area as other implants do.

That said, given you are in CA, why not consult with Terino about your cheek implants. He's a top implant specialist. If you consult with him, tell him "Miss J" sent you. He knows who I am.

Plastic surgeon
Miami, FL
United States
View My Professional Profile
  May 27, 2010 3:26 AM

Very complex question that should not be addressed over the internet. Travel to see Dr Terino as Miss J has suggested. Best of luck From MIAMI DR. B

  July 28, 2011 6:22 PM

you need to get a ct scan for starters and then u can use the skull model to design the best implants for your skull. I've been there.... custom design is the only choice if you are looking to correct facial deformity.



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