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Transcript
00:00Hey friends, I'm Stacey and this is Gorgeously Aging and today we are going to be doing cheek
00:04filler using Tesoro Implant. This is the Tesoro Implant with lidocaine, which means it has a
00:15little bit of numbing agent in the filler itself. This is a thicker, more cross-linked filler that
00:22is really great for cheek restoration. So as we age, our bones do start to deteriorate,
00:29it's called bone resorption. So not only do we have volume loss in the form of fat in our face,
00:35we also have bone loss as we age. Adding some mid-face volume to the cheek area
00:41helps to lift the lower face and restore some of that lost mid-face volume. Now it would be easy to
00:48go crazy with cheek filler and some people like that aesthetic. For me, I like to just enhance
00:53what I've lost over time with aging. You can see I have a little topical lidocaine. I started today
00:58by washing my face thoroughly and then I did a good alcohol swab before applying the topical
01:04lidocaine. I'm now going to remove the topical lidocaine and then we'll go over it with some
01:09more alcohol just to make sure the surface is clean, sanitized, and ready for the filler. So
01:15today I want to show you kind of a neat way of assessing where your cheek filler goes. You've
01:20probably seen a lot of lines drawn with intersecting points to determine where the cheek filler goes.
01:27I'm just going to show you a very easy and intuitive way to determine your cheek filler
01:31placement. Now that I removed the lidocaine, I'm going to go ahead and just take more alcohol and
01:36just make sure that area is prepped. Now alcohol can make your skin a little irritated and red,
01:43it does for me. So the redness here is just from the alcohol swabs. You may get a little redness
01:49from cheek filler itself and some initial inflammation and a little bit of tenderness
01:54in that area. That's totally normal and that lasts for a couple of days. So like I mentioned,
01:59in the Tesoro implant box you get two of these. Now I've already set up one of them. I'm going to
02:05use half a vial on each side and then assess if I need more. I'd rather come back at a later date
02:10and add a little bit more than to be too heavy-handed. My plan is to use this second vial
02:16for either the nose or nasal base because we also have kind of a sinking of the nasal base as we
02:24or to do a little bit of jaw touch-up. I haven't quite decided which one of those two I want to
02:28tackle first. So it's been since last November when I was in Korea that I did a cheek filler,
02:33so this is a touch-up. I could definitely wait longer but I kind of want to get ahead of this
02:38before the holidays. So this vial comes with two needles. One is a 27 gauge 13 millimeter
02:45and the other is a 25 gauge 13 millimeter. Now a 25 gauge has a larger opening so the product
02:51comes out a little bit easier. Either of these needles would be fine. My preference is the 25
02:57gauge. Now remember when you have a larger opening or a larger gauge needle you don't have to press
03:03as much and I'm going to show you how this comes out. There is 1.1 mils of product in here so I'm
03:10just going to use a little product to show you how it comes out of the syringe. Before we do that I
03:16do want to show you kind of an intuitive easy way to mark out where you're going to have your
03:21cheek filler. So you never really want to come closer in than the lateral part of your the
03:27colored part of your eye. So if you're on the outside part of looking straight if you're on
03:32the outside part of your eye let's just say that is the spot. We don't want to come in any closer
03:39than that. That's just a landmark there. Now feeling the zygomatic bone or cheek bone
03:48I'm going to feel the bottom of that and then lay my finger right underneath that ledge.
03:54I'm just going to go ahead and draw a line and then I'm going to feel my cheek bone
04:02just come right underneath that edge and draw a line and we're just going to kind of feel
04:10that zygomatic bone here. Now we want to enhance the lateral part of the zygomatic bone
04:18and so I'm just going to
04:23come down below the temple and I'm going to do one two three this is my cut off point and
04:33one two three that's my cut off point. So I'm just going to remove this dot so there is no confusion
04:44and certainly if you like to measure things out and do that technique that's a great technique
04:48as well. I've used that many times in the past. Now I'm going to probably stay on the high side
04:52of these dots but I don't want to get too high because if you build your cheek up too close to
04:57your eye then the cheek gets high here and the eyes can look more sunk in. Everybody has a unique
05:03anatomy and unique preferences. So let me show you how this comes out of the syringe.
05:15So it's not taking a lot of pressure because this is a larger needle gauge meaning the opening is
05:22more open allowing that thick filler to come through. If you have a really tight small needle
05:27gauge you have to put a lot of pressure on the syringe making it really difficult and sometimes
05:33impossible depending on the thickness of the filler. For this filler we're going to go straight
05:38in down to the bone. The tip of the needle will touch the bone. It doesn't feel painful you'll
05:44just kind of feel it the tip of the needle tap on that bone. We're going to pull back to aspirate
05:50to make sure we're not in a vessel. The reason why you go down to the bone is two reasons.
05:55One you're going to avoid any vasculature and two it's going to give you a nicer smoother finish.
06:01The closer you are to the surface the more lumpy and bumpy the filler can look. So I'm going to
06:06go right above these dots and puncture straight in. The tip of the needle is down to the bone
06:17slowly. You don't want to wiggle around. You want to be nice and slow, controlled,
06:25pull back, make sure there's no blood coming into that syringe. Now you also,
06:34I moved a little so I'm going to re-aspirate and go ahead and you want to try to stay as
06:41steady as possible and I'm going to do a nice bolus right on the bone.
06:57I'm going to go in and put a little more product right in the same spot.
07:02I'm going to aspirate again
07:18slowly
07:24and then we're going to go in here
07:26and we're going to go in right here.
07:33A little bleeding on the surface doesn't mean that you're going to have a vascular occlusion.
07:37It just means between the surface of the skin and the periosteum or the bone
07:41that you hit a vessel and it's going to bleed. That doesn't mean that something's wrong.
07:46So just reassure yourself that a little bleeding is okay. We're going to go in right here
07:57okay so far I'm quite comfortable
08:01and we're going to aspirate and you always want to have hyaluronidase on hand in case
08:06of emergency or vascular occlusion. Now I want to position my fingers here without moving around too
08:12much. With a thicker filler you do kind of need these two fingers here and a good thumb press.
08:20This doesn't go in as easy as a thinner filler so you do need to go nice and slow
08:25with some pressure and I'm just going to massage just gently those two spots here
08:36with this alcohol swab and then I'm going to go right above this spot here.
08:42Sometimes it takes a little bit of pressure to get it into the area. Now we're done. I can feel
08:59the tip of the needle at the periosteum and I'm going to do some aspiration. Make sure there's
09:07no flashback or blood coming into this part of the syringe. Get positioned without moving too much
09:16and slow and steady.
09:27Half a syringe is in this side of my cheek and it's going to be a little bit inflamed and
09:33sometimes initially it can look like it's too much. That generally settles down in a few days.
09:38The nice thing about restoring that cheek volume that's generally lost with age you get that really
09:45nice contour and it also lifts the lower face helping the jawline and the jowls. The cheek is
09:52the first place to address when you start to notice sagging in the lower face. Once you've
09:57done some restoration of that lost cheek volume then you can assess what might be needed in the
10:02lower face. A mistake people make is filling the lower face, the marionette lines, the nasolabial
10:08folds, and the jawline without first tackling the midface. Now thinner fillers like the fine or the
10:15deep just aren't strong enough fillers for this type of restoration. It really takes the implant
10:23or I have used the sub-q but I really do love the implant for cheeks. So now I'm just going to take
10:30and lightly massage this area. Not pressing too hard but just giving it a nice little massage
10:37and there we have it. It does give a nice lift and a subtle contour. Now after a week or so if I need
10:44more I can come back but I don't want to look overly augmented. I just want to look refreshed,
10:49lifted, and replace the lost volume. All right we're going to go right above this dot.
10:56A little twisty twist helps get it in there.
11:03And we're going to aspirate trying not to move around too much.
11:12No blood flash back there. Positioning of the fingers
11:17and we're going to go ahead and put a nice bolus here.
11:25It helps if you have a magnifying mirror so you can see how much is going into each one.
11:28So I've divided this into sixths. If they're slightly off just a tiny bit off each dot it's
11:35okay you just don't want to be majorly off at any one spot. Okay so we're going to go to this next
11:44dot. A little twisty twist to get it in there. I feel the tip of the needle at the bone.
11:54And aspiration here trying not to move around too much.
12:04And then go ahead and slow and steady watching that gray piece
12:09on the syringe go down.
12:15And we're in our last position now.
12:26Okay I'm feeling the tip of the needle there. Just a little you can just it's not painful it
12:30doesn't hurt you can just feel it. Okay so we're going to go ahead and put a little bit of
12:37you can just feel it you'll know what I mean if you've ever tried this. Holding this little
12:44aspiration staying steady and calm and we're going to use that remaining filler nice and slowly.
13:02And then we're going to pull out. You guys I think cheek filler is one of the most impactful
13:06safest and easiest procedures to do. The periosteum or bone is a safe place for injection and this
13:12actually I think is safer than using one of those hyaluron pens which just blows the filler
13:16everywhere with no rhyme or reason. Now some people when they're first starting may need a
13:22whole syringe on each side but it's always best to err on the side of caution. Less is more.
13:28Less is more you can always come back and add more but it's really not good to remove it unless you
13:37have to and it's an emergency. Removing filler can also remove your natural hyaluronic acid in your
13:42face and we really don't want to do that. I'm just going to do a little bit of massage here
13:47not pressing too hard. So I'm just going to take a little bit of lotion. This is
13:53the Bioderma lotion. You can use anything that doesn't have any perfumes. That's a real gentle
13:58lotion and underneath my zygomatic bone or cheekbone I'm going to press upward and then
14:05just gentle circles over where I put those boluses of filler just to kind of smooth it.
14:12It does you will feel three distinct lumps where those boluses of filler went but they do kind of
14:18soften into the skin over a couple of days. Because it's injected at the bone or periosteum
14:23you don't see the lumps and bumps on the surface but when you run your fingers across
14:28you can tell where you've put that filler. So I'm just gonna gently massage a little bit more
14:34firmly underneath. The other thing some people will notice once they've done their cheek filler
14:39is they'll notice more hollowing in the temples which is normal as you age and especially more
14:44pronounced once you've done some cheek filler. So I'll either tackle that with some volumizing
14:49threads which I think work great in the temple area. I have videos on that in my channel or I'll
14:56do some temple filler. So coming soon on my channel will be restoring some of this lost volume
15:02underneath the nose or the nasal base. This will help with a couple of things. As we age the nose
15:08tends to collapse a little bit into the skeleton. This will help push that forward just ever so
15:13slightly. You barely even notice but you look refreshed. The other thing this helps with is these
15:19nasolabial folds. It reduces the folds. Now we don't want to completely eliminate the nasolabial
15:24folds because that can make you look very very unnatural but to soften them is wonderful. And
15:30then in a future video I'll also tackle restoration of the jawline or just a little enhancement or top
15:36off and jawline filler will help keep a structured jawline and help with these jowls. If you found
15:43this video helpful, informative, educational, or useful for somebody you think would enjoy learning
15:49about this stuff as they're aging, hit that share button and text it to a friend. Facial rejuvenation
15:54doesn't have to be just for those who have tons and tons of money. With a little bit of studying
16:00you can do these things yourself safely and with great results. Thanks so much for watching. I'll
16:05see you in my next video.

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