CNN Türk İşimiz Estetik: Interview with Prof. Dr. Suleyman Tas on Non-Surgical Cheek Slimming

CNN Türk | İşimiz Estetik: Non-Surgical Cheek Slimming | Prof. Dr. Suleyman Tas

1. Right now, people want to have slim facial lines. There can be those who avoid and don't want surgery. What is non-surgical cheek slimming?

An oval face shape can make a person look heavier. There's a trend that celebrities in particular have started. Actually, this was something we already knew about and had been trying to apply before. Throughout history, a V-shaped face, with a more defined chin and sharper lines, has always been considered more attractive. It's also found in the golden ratio in the same way. More geometric, more defined faces are preferred. The procedure known as non-surgical cheek slimming has been built on this idea. In the past, with surgery, we would reduce the excess fat pads in the cheek area, known as buccal fat, creating a shadow between the cheekbone and the jawbone to give the face a slimmer appearance. But of course, that was a surgical procedure, and technology keeps advancing. Thanks to the method we've been using recently, we've gradually started moving away from that surgical procedure, because we've started getting good results with non-surgical cheek slimming.

So what is this procedure? Using ultrasound energy through a probe, we apply heat to this area from inside the mouth, from the inner part of the cheek, not from the outside, raising the temperature to around 50-55 degrees and causing the fat to melt. This melted fat is then eliminated by the body. Over time, this results in a slimmer cheek. We start getting a result similar to what you'd get from the surgery we call buccal fat removal.

If a person has particularly full cheeks, then we can do more than 2-3 sessions. With 2-3 weeks between sessions, meaning within a short period, after about 1-2 months, the shadow in the cheek area increases significantly, creating a play of light that gives the person a more attractive facial line.

1. Does non-surgical cheek slimming achieve results close to surgery?

This is a highly variable factor that depends on the person. Since it depends on the patient's anatomy, their fat ratio, the collagen content of their skin, and the skin's ability to tighten, it wouldn't be accurate to say anything definitive. Since all the procedures we perform are patient-specific, results can vary. However, when we look at the surgeries I've performed, we did have a limitation. There is a muscle-nerve area in the cheek region that we access from inside the mouth. To avoid damaging this area, we would only remove the upper part of the buccal fat and couldn't go further down. But a patient might say they also wanted the lower part to be slimmer. This kind of patient is a good candidate for the non-surgical aesthetic procedure.

During the non-surgical cheek slimming procedure, there is no chance of damaging any nerve. We can apply this procedure to all of the cheek fat. So when compared with this group of patients, you get a similar result. But there are cases where surgical removal is genuinely necessary. With non-surgical cheek slimming, nothing is lost, because there's no pain at all, and there's absolutely no interruption to daily life. After a procedure lasting 5 to 15 minutes, we can see the result after 1-2 months. So there's nothing to lose, and it's a genuinely helpful procedure. Thanks to the increase in temperature, we also stimulate collagen synthesis. Because of this, we create even a small lifting effect on the face and see some tightening. This is an added benefit for the patient.

1. When does the effect of non-surgical cheek slimming become visible?

Actually, we start seeing it right away. It starts settling in after 1 week. Since the collagen synthesis and tightening we mentioned, along with the process of the melted fat being cleared by the liver, take some time, we see the final result after 2 months.

1. How many sessions are needed for non-surgical cheek slimming? Do you decide on further sessions once you see the result, or do you determine the number of sessions needed just by examining the patient?

Studies have shown that for this procedure to be successful, at least 2-3 sessions need to be applied, with 2-3 weeks between each session. Now, in some difficult cases, where the cheek is very fatty and thick, we tell these patients from the start that 4-5 sessions will be needed, because it would be difficult to get a result after only 2-3 sessions. But for a routine patient, if the fat tissue we want to melt is within normal limits, then we plan for 2-3 sessions. This is not a one-session treatment.

1. When can patients return to their social life? How many minutes does the procedure take, and can patients continue their social life on the same day?

Now, when we compare this with the other local procedures we perform, we usually need some form of numbing, including local anesthetic cream. But interestingly, this procedure doesn't require any numbing at all, because it's completely painless. Picture an ultrasound probe with sensors at the tip that measure the temperature of the area; these sensors target 50-55 degrees and automatically shut off if it goes any higher. So it's a safe procedure. Inside the mouth, it's done with rhythmic movements like brushing your teeth, with the person performing the treatment moving the probe symmetrically and heating the entire area. Because it works using sound waves, there is no burn, no harm to the body, and no scarring or deformation. It sends radiofrequency-type waves that target the tissue beneath the skin. So it doesn't cause any damage to the surface and works in a completely selective way. It also doesn't cause any damage to the nerve. This procedure takes 15 minutes for each side. In total, you set aside about 30 minutes. After that, you can go right back to your daily life from where you left off.

1. Is local anesthesia required for non-surgical cheek slimming?

No, this procedure is quite interesting. Since we work entirely with sound waves and only raise the temperature in that area, there's no need for any local anesthesia. Otherwise, there are many sprays that dentists use to numb the inside of the mouth, and I actually keep these in my clinic too. At first, when performing the procedure, I wondered whether I should use one. Of course, I tried it on myself first. There is really no pain at all. You can think of this procedure like brushing your teeth. With movements just like brushing your teeth, we can complete the procedure completely painlessly, without any discomfort.

1. Can non-surgical cheek slimming be done on any facial contour?

We've talked about skincare, about botulinum toxin... we've covered almost every kind of aesthetic procedure. I compare this to the saying, ‘The more you water a flower, the more it opens up for you.’ So when we look at how this works and the results we get, it comes down to collagen production, and collagen is what forms the cross-links between tissues. After a certain age, the enzymes that produce this collagen decrease in us, while the enzymes that break it down increase. This balance tips in favor of breakdown, so a breakdown process has already begun in you. The treatments we apply from the outside either supply the substance that's already been produced or trigger the body to increase its own production. You can do either. Coming back to the procedure we're discussing, it triggers the collagen synthase enzyme and increases its production; at the end of the day, we see a tightening in the area beneath the skin known as the dermis, and together with the melting of the fat, this tightening becomes visible on the outside.

1. What should be paid attention to after the cheek slimming procedure?

For example, when we perform botulinum toxin, we tell the patient not to bend forward afterward, since it has a 24-hour binding period, and not to touch the area with their hands... But with this procedure, there's nothing like that to watch out for. With lip filler, we apply local anesthesia and there's some numbness in the lips for a while, and we tell patients not to drink anything too hot or too cold. Since we don't apply local anesthesia in this procedure, there's no such issue here either. In other words, there's nothing at all that the person needs to be careful about. That's our whole goal: we always try to bring every surgery, every aesthetic procedure, to a higher level, just like this one. There will always be some limitation; this will never truly be finished. But we will always keep pushing to find out how we can do it better.

1. After you started offering non-surgical cheek slimming, have you ever referred a patient to surgery instead?

That's a very good question. To be honest, I used to perform quite a few buccal fat removal surgeries in my practice. I work especially in facial surgery. I slim down the contours of the nose, and after that, you also need to work on the other lines of the face to achieve that same refinement, to get a more aesthetic result overall. As aesthetic surgeons, when a patient comes in and describes their concern, as the ones who know the field, we always tell them how they can achieve the look they want and what else might need to be addressed. We ask them to take this as our professional opinion, think it over, and come back to visit us again afterward. I used to perform buccal fat removal surgery quite often, and it really is a commonly performed procedure. There are a lot of things you have to be careful about during this surgery, such as not damaging the buccal nerve. Patients with fuller cheeks usually preferred this surgery, and we don't want to risk damaging the nerve. So this group of patients can benefit from non-surgical cheek slimming instead. In buccal fat removal surgery, you also have to be careful that no sagging occurs in the face when the fat is removed. Another advantage of the non-surgical procedure is that there's no sagging. But unlike the surgical procedure, the result isn't seen immediately. At the end of the day, both procedures have their own advantages and disadvantages. There's a procedure suited to each person. These are simply options, and the more options there are, the more likely we are to make people happy. If you can choose the procedure that suits you, then you'll have found the procedure that can make you happier too.

1. If we gain weight, might we need non-surgical cheek slimming again?

You shouldn't gain too much weight. But the procedure performed here is permanent. When we melt the fat, the number of fat cells decreases. When you gain weight, these fat cells increase again. A change in body mass index will affect the result of the procedure performed on the cheek.