19 Yr Old Sagging Cheeks, No Fullness on Cheekbones Very Full Lower Cheeks. What Can I Do?

IT is clear that you are being highly critical of your appearance. it is difficult to make a recommendation at your age as this is highly unusual and the long term results of this intervention may not be completely predictable. Buccal fat extraction could help but could produce an excessively gaunt appearance in the future. Injectable fillers to the cheeks would allow you to preview the results but this would require maintainance. Longer term results could be achieved with fat grafts or cheek implants.

Your photo looks like there is a pillow behind your head. If that is the case and the photo was taken with you lying on your back it would be impossible to make any recommendation based on this photo. I would need to see frontal, side and oblique view photos or a face to face examination in order to make any specific recommendation.

I would need to see your profile to determine the need for a chin implant. I do not like removal of fat in the lower face as you will need this fat as you age. It looks like cheek implants would give you the best result without having to keep using fillers.