Focus on: cheekbones

The cheekbones are an important frame for the face and having ‘great cheekbones’ is one of the best compliments that a face can have! Jonny Depp, Angelina Jolie and Sophia Loren have ‘great cheekbones’, but what is actually there and how can this look be achieved and maintained? Cheekbones 7

Although it is the zygomatic bones that provide the structure at the top of the cheeks, what creates a youthful face is the fat pad that lies under the skin.

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This malar fat pad rounds out the cheekbone and provides a smooth, unbroken curved appearance. Unfortunately it drifts downwards during the 30s and 40s leaving a flat mid-face (and contributing to the formation of the dreaded jowls look).

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In youth the face can be thought of as having a schematic outline of an upside-down triangle with the cheekbones providing the width and the face narrowing down to the chin. A combination of changes take place with aging – the maxilla bones in front of the cheekbones shrink inwards flattening the area under the eyes, the malar fat pad drops down and forward and the skin loses some of its elasticity and sags with wrinkles and folds becoming more evident. This upside-down triangle becomes more square and, as jowls develop and the nose-to-mouth folds deepen, develops into a pyramid with the base at the bottom of the face.

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As well as the cheeks losing their roundness of youth, grooves appear under the eyes as the boney margin of the eye socket, the infraorbital rim, is uncovered. These contribute towards the bags under the eyes that are a part of middle age with loose, wrinkled skin in evidence on the surface. The nose-to-mouth or nasolabial folds (NLF) deepen and are one of the most commonly requested areas for correction. This lack of volume in the cheeks may also be present from youth resulting in an early aged or tired appearance.

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Although these changes inevitably happen with ageing, facial aesthetic treatments can slow the process. The   current way of envisaging the face is as a balloon. Initially it is properly inflated but, with time, it deflates and wrinkles form. Fillers are often used now to ‘reinflate’ the balloon and regain the lost volume. Regaining the volume of the cheekbones that has been lost will lift and tighten the skin below and can produce effects beyond the immediate treatment area. Vectoring is a further filler technique that works against the pull of gravity. Vectoring lifts the mid and lower face with strategically placed fine lines of filler that provide support, normally anchored to the cheekbone area.

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Fillers are the most popular non-surgical treatment for the cheekbone area but other treatments can also be successfully used. Surgical face lifts can reposition the sagging parts of the face (but fillers are now commonly used to replace the volume of youthful facial fat that has been lost). Ageing skin can also be treated with ‘resurfacing’, removing the top layers of skin to stimulate new growth, and this can be achieved with chemical peels and dermabrasion. This will provide a ‘glow’ to the skin and can remove age spots, but only very deep peels, such as phenol, can significantly correct wrinkles and folds.

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Everyday methods for keeping the skin over the cheeks healthy includes good hydration by drinking enough water, a healthy diet, a good skin cleansing routine and sun care. The top of the cheeks are particularly prone to sun damage as they face upward and sun cream throughout the year is recommended. There is a more detailed explanation of these in the General skin care advice section of the site.

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