Jowls & Chubby Cheeks

Fractional Energy Devices

Fractional Infrared Lasers

Fractional laser resurfacing involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue resulting in both greater efficacy and shorter downtime compared to non-fractionated treatments. It can be further subdivided into ablative and non-ablative. Ablative fractional lasers have longer wavelengths (e.g. CO2 10600nm) and lead to full-thickness destruction of skin, whereas non-ablative fractional lasers have shorter wavelengths (e.g. Erbium Glass 1550nm) and leave an intact skin surface. CO2 has greater efficacy compared with Erbium Glass but longer recovery time and a higher risk of complications.

Fractional Infrared Lasers have a good body of research evidence demonstrating safety and efficacy.

Fractional Picosecond Laser - Discovery Pico Plus

Discovery Pico Plus is a second-generation triple wavelength picosecond laser that generates the highest peak power in the world. A special microlens array further focusses the energy into numerous micro-beams 2mm under the skin. The highly concentrated energy produces laser-induced optical breakdown (LIOB) stimulating collagen production with almost no downtime.

Fractional Bipolar Radiofrequency

Fractional Radiofrequency creates a pyramidal thermal injury zone (a relatively large coagulation zone deep in the skin with minimal surface damage) as opposed to the columnar shape of ablative lasers. Hence Fractional Radiofrequency has a favourable side-effect profile (such as downtime, post-inflammatory hyperpigmentation) in comparison to fractional lasers.

Fractional Microneedle Radiofrequency

Skin remodelling requires heat delivery to the deep part of the skin. However, in most machine-based treatments for scarring such as lasers, much of the energy is dissipated at the skin surface and little reaches the deep layers. Fractional microneedle radiofrequency overcomes this using insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, resulting in faster recovery, higher efficacy and increased safety.

Subdermal laser or radiofrequency

A tiny probe inserted under the skin is used to conduct laser energy or radiofrequency energy that is absorbed by the skin and surrounding tissues, stimulating collagen contraction and production to tighten loose skin, reshaping bulging or loose tissue.

High-Intensity Focused Ultrasound

High-intensity ultrasound energy is focused precisely on the targeted fat layer, creating a rapid rise in local temperature at the targeted area without harming surrounding skin, tissue or organs. HIFU relies on the fact that, above a threshold of 56 degree C (for > 1 second), irreversible cell death occurs. The heat produces a dual tissue response within the treatment area - permanent destruction of targeted fat cells and contraction of surrounding collagen that helps improve tissue laxity. The body naturally removes the destroyed fat from the treatment area, reducing the size of a fat deposit.

Injection lipolysis

Belkyra / Kybella is a synthetic form of deoxycholic acid, a substance that is otherwise naturally produced by the body and that helps absorb fat. Deoxycholic acid has the potential to kill fat cells. The body gradually metabolizes the dead cells during the weeks after treatment.

Fillers

Injectable dermal fillers are hydrogels that can be implanted to enhance the shape and contour of the nose. They can be classified into temporary, semi-permanent and permanent fillers. Temporary fillers are most popular and can be classified into 2 broad groups:

• mainly volume replacement - most commonly composed of hyaluronic acid, a naturally occurring glycosaminoglycan polysaccharide which draws and binds water to itself and the surrounding skin. Other examples include agarose or collagen
• collagen stimulating - contain materials such as calcium hydroxyapatite, polycaprolactone that cause the body to produce collagen

Fillers have different structural properties such as cross-linking that manifest in their rheological properties such as viscosity, cohesivity, hardness and resistance to deformity. Hard, cohesive and viscous fillers are preferable for structural support as they keep their shape well. Soft or medium viscosity fillers can also be used for certain softer areas such as the undereyes.

Jowls and chubby cheeks may be present even in a young and otherwise slim face. Often, however, they grow more prevalent with age.

Essentially they can be viewed as collections of excess fat in a loose skin / muscle pocket comprising a facial compartment which may have deficient underlying bony support.

These factors contribute to varying extents in different individuals hence it is necessary to analyze each patient individually with 3D imaging and especially feeling and measuring the area to find out the relative contribution of each factor and address each factor appropriately:

• Filler in the marionette lines and jawline to soften the borders of the fat compartment and increase the bony support of the jawline
• HIFU with deeper focus depth to reduce the excess protruding buccal / jowl fat
• HIFU or subdermal laser / radiofrequency also be used to tighten the walls of the fat compartment and lift the fat pad
• Fractional energy devices to address any laxity of the overlying skin

Dr Wan Chee Kwang

FOUNDER / MEDICAL DIRECTOR