Instant Cheekbones Lauren Bacall taught Humphrey Bogart how to whistle with her lips, but it was her killer cheekbones that really made him pay attention. Sure, she had good genes-and youth-going for her. But it was the fierce angles of her face that the camera loved and that later helped her age so well. "Strong cheekbones reflect light and add symmetry," says Fredric Brandt, the New York and Miami dermatologist. "All classic beauties have them."
Even for those of us without epic bone structure, cheekbones are the scaffolding that holds up the face. Unfortunately, as we age, our cheekbones lose volume, and without that underlying structure, skin and muscle start to slide, forming decidedly unlovely jowls and folds. Until recently, the standard line of attack against a sagging visage was either plumping with fillers (which too often can end up looking more chipmunk than chiseled) or getting a face-lift. Now, however, new techniques have doctors rethinking the facial landscape. Suddenly, building up the cheeks has become the ultimate solution in antiaging. "When you fill in the cheeks, everything is pulled up," explains New York dermatologist Patricia Wexler. "You diminish the nasolabial folds, decrease the downturn of the mouth, and reduce the hollow of the eye, all without touching any of those areas."
Though fillers, or "liquid face-lifts," remain popular, an increasing number of women are turning to a more permanent solution to shore up their facial architecture. According to the American Society of Plastic Surgeons, cheekbone augmentation surgery among women in 2011 increased by 45 percent over the previous year. "Cheek implants can take 10 years off your face," says New York plastic surgeon Sam Rizk.
Yet the fear of waking up with cliff-hanger cheeks to rival Herman Munster's keeps many women out of the operating room. "I was definitely worried I'd end up looking like Madame the marionette," says Kara*, 44, a fashion stylist in Boston. Along with combating the first signs of aging, she wanted to balance out an overly prominent jaw, and in the end she and her doctor, Michael J. Yaremchuk, chief of craniofacial surgery at Boston's Massachusetts General Hospital, decided that implants were the best solution. "Implants today are more natural-looking," Yaremchuk says. "In the past three years, we have been able to use computer imaging to take a scan of someone's skeleton, see the inadequacies, and then make implants that are a custom fit. It's bespoke plastic surgery." Naturally, couture doesn't come cheap. Standard implant surgery ranges from $5,000 to $10,000. The additional personalization can tack on another $5,000. The implants are permanent (though they can be removed if there's a problem) and are made of silicone or porous polyethylene, each of which is FDA-approved and unlikely to cause an allergic reaction. And because the implants are placed through incisions inside the mouth beneath muscle, they feel natural to the touch and won't cause scarring. Surgery is on an outpatient basis, using general anesthesia. Plus, the risks are minimal. "As with any surgery, there is a 1 to 2 percent chance of infection," Yaremchuk notes, and a much smaller one for nerve damage. Recovery tends to take two weeks but can vary. "I didn't really look normal for the first two weeks," Kara recalls. "I remember going to work after 13 days and coming home and crying and wishing I hadn't done it; I felt tender and raw. But after one month, I had my picture taken at a big society event, and I looked great. I have a much better proportion to my face, yet I still look like me."
Not everyone feels that surgery is necessary. Brandt, who pioneered the use of fillers in cheeks, insists that he can rebuild the planes of the face with well-placed injections. "Hyaluronic acids like Restylane and Perlane are my favorite because they're fairly stiff," he says. He places the filler beneath the muscles, like implants, and balances it out by adding a bit to the temples. The results last anywhere from six months to a year, and there is virtually no downtime (usually just minor swelling). Depending on the amount of filler used, the cost ranges from $1,000 to $3,000.
For many women, fillers are the gateway drug to implants. Anna*, 49, a financial consultant in New York, had gotten Restylane and Juvéderm injections for a few years before stepping up to implants. "Fillers weren't doing it for me anymore," she says. "It was hard to schedule appointments every six months, I was bruising each time, and the cost was adding up." She ended up getting silicone implants from Rizk. (The cost, including hiring a private nurse for two days, was $19,000.) "I felt more discomfort than pain," she continues. "I went back to work in seven days. I was pretty bruised, but I was able to hide it with makeup." Now that the swelling is gone, Anna says, she looks five years younger. The only problem? "My cheeks look great, but now I think my neck might need some help!"
*Names have been changed
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