Best Fillers for Large Hollowed Areas?

I'm a 37-year-old female. While my facial skin still looks quite fresh, my cheek bone and jawline areas are so hollowed they make me look tired and old. I've considered Sculptra and other dermal fillers, but I'd like to know if there's anything long-term or permanent for restoring these large hollowed areas.

Doctor Answers 9

Structural Fat Grafting or Microfat Grafting to Correct Facial Hollows

A number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume.

Some synthetic materials are available which can be used in an attempt to produce a permanent soft tissue augmentation. Unfortunately, the body treats such materials as foreign objects, and as a result the placement of synthetic materials may lead to inflammation, infection, migration and granuloma formation. In general, synthetic materials are less likely to produce a result that looks and feels natural.

The grafting of autologous (your own) fat to reliably restore or improve facial volume is now possible. The fat is harvested from the abdomen, thighs, hips or buttocks using specially-designed instruments and a specialized technique, processed (by centrifugation, which eliminates all components of the harvested material which is not viable fat), and meticulously injected into the facial areas to be enhanced.

Fat grafting has been performed by plastic surgeons for decades. There is no question that fat is the ideal material for soft tissue augmentation, and that the results obtained with fat grafting are the most natural-appearing. However, one problem with this procedure in years past has been resorption (breakdown) of the grafted fat, so that the resulting improvement is not permanent. The grafted fat must gain its own blood supply in its new location in order to persist long-term, and this generally is not possible when large amounts are injected at once and when specialized instrumentation and techniques are not employed.

Structural fat grafting , or microfat grafting is different than traditional fat injections or fat transplantation . With structural fat grafting, small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.

Fat Grafting requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Fat grafting is a nice, natural facial filler.


Not all fillers are appropriate for all people or all locations on the face. Around the lips and nasolabial crease, the HA products such as Restylane, Juvederm and Prevelle work well. Evolence, a collagen-based product is also good in these areas. For the cheeks, Radiesse or Sculptra are nice fillers as they provide more substance and structure after injected. Be very careful with permanent or long-term fillers since you can not easily remove them if you do not like the results.

One of my favorite fillers is your own fat (from your abdomen or thigh). I remove the fat with a mini liposuction technique and then isolate the fat cells using centrifugation. The fat cells are then transfered into syringes in preparation for injection. One of the nice things about using fat is that most people have an unlimited supply. Therefore, much larger areas can be corrected without having to spend the money on multiple syringes of artificial injections. Another benefit of fat injections is that it is natural - it is your own fat. If your body incorporates the fat, you have the potential of significant long-term effects.

I hope this is helpful.

David Shafer, MD

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

We prefer LiveFill or Juvederm

Sculptra is a nice filler for deep areas and is approved for severe lipoatrophy associated with HIV. It usually requires several injections and eventually dissolves. The results seem to be longer lasting than with hyaluronic acid fillers, although the study for lipoatrophy allowed the doctors to reinject a few times before the study was done, clouding the results somewhat. We do not use Sculptra in our practice because of the current FDA limitations and the problems that have occurred when it is injected underneath thin skin, i.e. the lower eyelids.

Some very well tested high safety profile fillers for deeper three dimensional areas are Juvederm Ultra Plus and Restylane.

We avoid the use of any semipermanent filler with polyacrlamide beads, silicone in any form, or hydroxyapatite because of the risk of granuloma formation (permanent lumps), migration of the filler or chronic lifelong swelling (silicone).

Many doctors perform fat injections, but the effects are often seen as long lasting but ultimately largely temporary as the nonviable cells are metabolized away.

For patients interested in a more permanent filler, we use LiveFill, nontraumatized fascial fat grafts fashioned from the patient's own tissues. We have had success with filling hollow areas of the face and have been able to document the survival of the grafts long term with 3-D CT scans. This is a surgical procedure, not an injectable.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Sculptra fills hollows best

Hi- while most fillers will do an adequate job of improving moderate to deep wrinkles, the best (and only) filler I use to fill out hollowed areas is Sculptra. Sculptra, in fact, was designed for this purpose and before being used to treat the aging face, was used in the management of the facial wasting experienced by AIDS patients, with great success.
It wasn't long before the similarities between this wasting and the loss of volume that can occur with aging was noted, and Sculptra has since been found to be equally successful for this purpose.
Because it is a very artistic delicate procedure, Sculptra is only available through your Board Certified Plastic Surgeon or Dermatologist, however.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 157 reviews

Fillers for cheek hollowing

Yes, Sculptra has been used in this area but it can be very expensive. Some other fillers are autologus fat grafting ( this may require multiple treatments) or Radiesse.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Consider Radiesse as an alternative

An alternative to Juvederm, Sculptra and fat injections is Radiesse. Radiesse is composed of tiny, smooth microspheres of calcium hydroxylapatite suspended in a gel matrix. These microspheres form a scaffold through which normal collagen grows, producing a long-term filling effect. Because Radiesse contains a component naturally found in our bones and teeth, but does not contain animal collagen, it does not require a skin test. Radiesse can be used to build up areas given structural support. I like to use Radiesse to improve volume

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Fat or Sculptra are your only good options

The areas which you are describing for fill routinely need 3-5 mls of fill per cheek. Fat is the only natural filler and also the only one available that can fill that area. Previous complaints about fat survival surround the use of the centrifuge, which kills many fat cells.

A new technique called The Viafill system has just been FDA approved and will provide a much higher content of live cells for injection. This system should be available in April from your local plastic Surgeon.

Sculptra uses inflammation to provide the swelling necessary to create volume. treatments must be repeated often. It is beneficial for those who are extremely thin, but for the rest of us - fat is best.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Consider fat grafts

Loss of volume (fat) in the face contributes to the appearance of aging. A youthful face has more fat, and so grafting your own fat should provide a long-term and natural result. HA fillers such as Juvederm and Perlane work well, and should give a result lasting 6-12 months. I am not a fan of Sculptra, since it requires a series of injections and the results are not immediate.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Fat Transfer Best for Long Term/ Permanent Restoration of Large Hollowed Facial Areas

Hi Vegas Doll,

The best long term/ permanent solution for your facial hollows is fat transfer. When performed properly, fat transfer has been shown to be permanent. The procedure is extremely surgeon dependent, so it is essential that you research and choose your treating surgeon most carefully.

See you at the 2009 World Series of Poker, until then put $25 on red for me. Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.