Asian descent - Options for flat mid face? (Photo)

Hi! Dr. Peterson here –
You’re right that midface projection can make a big difference in facial balance, and what you’ve described sounds like it would benefit from a very refined, subtle approach. Your face is already beautifully structured, and I would honestly recommend working with someone who is not only skilled technically but also has an artistic eye — almost like a sculptor — since the goal here is not to create a new face, but to bring out the natural contours you already have.
For most patients in your situation, I would start with a very small amount of hyaluronic acid (HA) filler in the cheeks and along the piriform area. Even 1 cc total, placed with precision, can make a meaningful difference. The key is restraint, because it’s always easier to add more later than to take filler away.
Another great option is Sculptra, which works differently. Instead of providing immediate volume, it stimulates your own collagen production over time. This makes it ideal for someone looking for gradual, natural improvement in contour and skin quality without the slightly more “instant” effect of HA fillers. It tends to give a softer, more integrated result and can last longer.
Implants are a surgical option that provide a longer-term solution. They can add significant projection but involve surgery, recovery, and permanent hardware.
Le Fort osteotomies are major facial surgeries usually reserved for functional concerns (like bite issues) or patients seeking a very significant structural change. They’re not typically the first-line cosmetic option unless there’s also a skeletal imbalance.
My recommendation is usually to start with filler, because it’s effective, customizable, and doesn’t lock you into a permanent change. If you love the look, you can later consider implants or longer-term options.
Warm regards,Dr. Erik Peterson

Thank you for your thoughtful question. Flatness in the midface is a common concern, particularly among individuals of Asian descent, due to natural differences in facial bone structure and soft tissue projection. You’re absolutely right that sometimes a rhinoplasty can highlight midface volume deficiencies rather than solve them.

Here are the main options available:
1. Cheek Fillers (Malar/Midface Filler)
Minimally invasive and often the first-line treatment.

Adds volume to the malar (cheekbone) or submalar area to create more forward projection.

Results are temporary (typically 12–18 months) but effective in restoring balance.

Great for testing whether adding volume to that area improves overall harmony before considering surgery.

2. Pyriform Aperture Filler
Targets the area just next to the base of the nose.

Can support the nose base and lift the midface subtly.

Often combined with cheek fillers for a more cohesive and natural correction.

3. Facial Implants
Permanent solution compared to fillers.

Cheek implants or paranasal (pyriform) implants can enhance structure and projection.

Typically performed by facial plastic surgeons or oral maxillofacial surgeons.

Requires downtime and carries more risk than fillers but has long-lasting results.

4. Le Fort I Advancement (Orthognathic Surgery)
A major surgical procedure involving bone movement, typically reserved for severe skeletal deficiencies or malocclusion (bite misalignment).

While it offers structural correction, it’s not typically needed for mild to moderate midface flatness, especially if your concern is aesthetic rather than functional.

Recommendation:
For most patients with mild to moderate midface flatness, starting with hyaluronic acid-based cheek and/or pyriform fillers is the safest and most efficient way to see if volume restoration provides the improvement you’re looking for. If you’re happy with the change, you can continue with maintenance treatments or eventually consider implants for a longer-term solution.

Orthognathic surgery (Le Fort I) is rarely necessary unless there are structural or dental indications beyond cosmetic concerns.

There are both temporary and permanent solutions. Fillers can be placed to reduce the flatness, but they will need to be replaced yearly. Silicone cheek implants would offer a more permanent solution.

One of the features of the Asian face is malar hypoplasia (small cheek bones), which creates flat, sometimes concave midface. Placement of cheek implants of different size/shape may correct this condition. In person consultation with a board certified plastic surgeon with expertise in facial implants is recommended. Good luck.

If your teeth fit together well you don't need a lefort surgery. It is complex and involved. It is likely that we can get a fantastic outcome with either cheek implants or fat grafting. Both can be done right in the office.

In terms of simplicity and achievement of immediate results, the use of a robust HA volumizing filler for a nonsurgical cheek augmentation would constitute a very reasonable approach to addressing your concerns. In the hands of an expert, board certified cosmetic dermatologist filler expert, this can typically be achieved in one treatment sessions of about fifteen minutes, and with little, significant post-treatment downtime. It would also allow for reversibility with hyaluronidase in the event of necessity or desire. Hope this helps and best of luck.