INTRODUCTION
Injectable fillers are sought out by patients as an attempt to alter their self-image, leading to an improved feeling of attractiveness. Recently, facial volume has been recognized as a key feature in our perception of youthfulness. Recreating volume in an aging face has been shown to reduce the perception
of a patient's age by 4 to 9 years.1 Perceived age is one way to measure a patient's response to fillers, but it doesn't tell us directly if a woman feels more attractive. It has been shown that women perceive themselves as more attractive than others,
2 which is postulated as a result of a need to be able to function confidently. This has been confirmed in another study of women presenting to a dermatology practice for cosmetic treatments.3 The current study was undertaken to determine whether cheek augmentation could improve a woman's perception
of her own attractiveness.
METHODS
The first 10 eligible women who were willing to participate in the study were chosen. The only inclusion criterion was that they were between the ages of 40 to 60 years. Exclusion criteria included no cosmetic treatments for the last 6 months, no significant
medical history or autoimmune diseases, and no active infection on the face. They were not prescreened for level of attractiveness,
weight, or judgment of whether the augmentation would be beneficial to their appearance.
Patients were asked to rate themselves on a visual analog scale (VAS) of 6 (Figure 1) as to how they felt about their facial appearance.
Patients then received a total of 2.0 cc of hyaluronic acid (Perlane, Medicis Corporation, Scottsdale, AZ) into their malar cheeks. The technique used by the investigator was raising the cheek with the non-injecting hand's thumb or second and third fingers and injecting under the elevation at approximately a 45° angle to the mid-superior portion of the zygoma approximately 2 mm to 4 mm lateral to, medial to, and at the same level of the lateral canthus. Three to four boluses of material totaling 1 cc were injected into each cheek using this method. The material was massaged if necessary to make the skin palpably smooth. The patients were given usual instructions about postoperative care for fillers and asked to return in two weeks. After treatment,
the subjects completed another VAS asking how they felt about their own facial attractiveness.
RESULTS
Facial attractiveness was perceived as being at least 0.5 to 2 points higher on a 6-point scale by 7 out of 10 patients (Table 1). Two women perceived their attractiveness as being unchanged and one woman rated herself 4 points worse after the treatment. No significant side effects were noted; some subjects noted transient bruising, swelling, and modest discomfort. Results of subjects who recorded a 1- to 2-point difference are shown in subjects' before and after photographs (Figures 2 to 4).
DISCUSSION
Self-perception of facial attractiveness is a complex set of subjective
emotions that are most likely either rooted in or stimulated by brain neural impulses.4
It is well documented that we rate our own attractiveness higher than would other objective viewers.2 A dominating factor
in the assessment of facial attractiveness by others is age.2 A younger version of our own face is something that could resonate when we look in the mirror. An MRI study of female cadavers shows that inferior migration of the facial fat pads is much more pronounced in elderly women than in those of middle age.5 It stands to reason that if we could restore volume
