UPPER CHEEK LINES
Cheek wrinkles are associated with crows feet and under eye lines and occur when a person smiles, using the cheek muscles and the orbicularis oculi muscle. Over time, these lines etch in permanently and are there even when the person is not smiling. These lines can extend and eventually join the dynamic smile lines in the lower face
Treatment of upper cheek wrinkling
Cheek wrinkling needs to be treated with muscle relaxing injections and with dermal filler. The dermal filler should be injected for cheek support and into the lines. Muscle relaxing injections will help the “dynamic” wrinkling ie the wrinkling that occurs on smiling.
Muscle relaxing injections are used to treat cheek wrinkling is (due to Australian regulations, we are not allowed to name the drugs used)
Multiple small injections using a very fine needle are performed to the cheek and under eye area where the lines are located on smiling. Somewhere between 2-7 injections on each side will be performed.
Treatment with dermal filler in the cheek and under eye area is also important because as we age, there becomes a lack of support in the area.
The consultation for antiwrinkle injections for cheek wrinkling
History-taking is very important in the treatment of cheek wrinkling. The following should be explored:
Has the patient had treatment before?
Were they happy every time?
Did the antiwrinkle injections last well?
Which area came back first?
How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
Is it the crow’s feet to the side of the eye, or those underneath the eye which are bothering the patient or both. Is it only the lines in the lower eyelid or is it also the lines that extend down the cheeks which are worrying the patient
Have they every had any complications from previous treatments, eg e strange smile etc
Does the patient want a more natural appearance, with some lines left, or do they want the maximal effect possible?
The doctor will examine the face and under eye and cheek wrinkling. In particular, she will look at many features, such as:
Where the lines are.
Whether there is any asymmetry
Whether there is a bulge in the lower lid.
How far the crow’s feet extend down the side of the cheek
Choosing the dose of toxin
The doctor will assess the face and decide on the best dose after taking a history and examining the patient.
If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.
Pain relief during cheek wrinkle injections
A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Most patients do not bother with numbing cream because it takes so long to work and because the treatment in the crows feet isn’t very painful anyway.
Ice is always used to decrease pain and to reduce the risk of bruising.
Very rarely patients will use Penthrox for under eye treatments
Nitrous oxide (happy gas) is available during the crows feet treatment to reduce the pain
What happens during the cheek wrinkle treatment itself?
The face will be cleaned with alcohol.
Ice will be applied to the area briefly before treatment
The doctor will inject approx 10 sites around the under eye and cheek on each side. Then pressure with gauze will be applied.
The procedure itself takes less than 5 minutes.
How do I look afterwards?
Sometimes there is nothing to see. Sometimes there can be redness, small lumps, which can look like mild acne and usually resolves quite quickly.
Most people could come during their lunch break during work and go back to work without their coworkers noticing anything
Typical problems which can occur:
In general, treatment of the under eye and cheek is very low risk. Most of the antiwrinkle injection problems occur from treating other areas of the face
Headache happens in around 10% of new users.
Bruising occurs in a significant number of cases.
Asymmetry: Sometimes one side is better treated than the other, this is usually because the patient is asymmetrical to start with.
Infection is a very rare complication, but always a possibility when the needle goes into the skin.
When the under eye/ cheek area is being treated with antiwrinkle injections, there is a risk of a “cosmetic patient”-like appearance, ie the smile doesn’t appear natural. Also with even bigger doses and more risky placement, smile asymmetries are possible
Instructions for care afterward
No makeup for 4 hours
No massage that day
No heavy exercise that day
No lying down for 4 hours
Lots of smiling suggested for a few hours
Lay off the acid face products for 24 hours
What to expect after cheek wrinkle treatment?
The effect of the injections may begin to be noticeable after 2-8 days.
The maximal effect of the drug will be at 3-4 weeks, so a review should be booked in at 3 weeks (only after the first treatment, for subsequent injections, a review appointment shouldn’t be required)
What if I get asymmetry at some time before the 3 week point? Do I call the doctor?
No. No need to call the doctor. Sometimes asymmetry will occur because one side just comes on quicker than the other. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be treated at the review appointment. There is no point in coming in early for treatment of asymmetry. In other areas of the face, treating asymmetry too early could lead to droop or further asymmetry
How long will the cheek antiwrinkle treatment last?
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
Typically this is what happens:
At 3-4 weeks, there is a maximal effect
at 8 weeks, movement starts to return
at 12 weeks, 50% of movement should be back
at 16 weeks 80% of movement should be back.
For most patients, this is very close to what occurs.
When should I have my next treatment for under eye wrinkling?
Patients should be retreated when the movement is between 50%-80% back ie sometime from 3-4 months.
We recommend 3 months as the best option for cheek wrinkling
Some patients like to come back for re treatment at 8 weeks
Price for antiwrinkle injections in cheek wrinkling
Typically $360. If other areas being treated then the price will be reduced
Price for crows feet and cheek wrinkling together
Other procedures which would be suitable to combine with antiwrinkle injections in upper cheek lines
* Microlaser Peel
* Fractional laser
* Dermal Fillers
* Skin Boosters