Best Filler for Cheek Hollowness?

When it comes to restoring volume to the cheeks, there are a number of good fillers. I discuss all choices with patients. They range in longevity, ease of injection and cost. Basically the longer it lasts, the more it costs and injection is slightly more complex.

First choice is hyaluronic acids: Juvederm and Restylane. These last from 6 to 9 months in the cheeks. Next in price and longevity is Perlane and Juvederm Ultra Plus (9 months or more). These are a little thicker, so may feel lumpy (but rarely do). The needle is a little bigger as well so there may be more "black and blue." Next in line is Radiesse, in expense and longevity. The longest lasting filler is Sculptra. Recently FDA approved for cosmetic uses, it takes three treatments but then may last two years or more.

By the way, these also help the naso-labial lines by lifting the cheeks up and out.

Sculptra, Perlane or Juvederm are my favorite options for cheek hollowness.

Sculptra requires 3 or more monthly sessions and several months or more to see the final results.  Sculptra may last longer - up to 2-4 years or maybe more.

While, Perlane and related hyaluronic acid-based fillers are performed in one session, but will probably require 2-3 or more syringes for satisfactory improvement; which lasts 1-2 years or less.   Final (total) costs are similar.  Hyaluronic acid-based fillers are easily reversible if the resultra not satisfactory.

A wide variety of facial implants are currently available for the enhancement of the skeletal elements of facial aesthetics. The most commonly used facial implants are used to enhance the profile of the chin and the cheeks. Facial implants very widely not only in shape and style, but also in terms of the materials from which they are fabricated.
My preference is to use structural fat grafting, as much as possible, to enhance facial features. In many cases, the need for a solid implant can be eliminated by the careful and meticulous grafting of a patient's own fat. While the incidence of complications with facial implants is not high, certain problems may develop which require implant removal including infection and implant migration. Bone resorption (bone loss) has also been reported below solid facial implants. Neither of these problems are an issue with structural fat grafting.

The only setting in which I currently use a solid facial implant is for chin implant augmentation. Some patients with a 'weak' chin profile can be adequately improved by structural fat grafting alone. However, when the chin protrusion needs to be enhanced by a half centimeter or more, a chin implant is absolutely required. I prefer to use a soft, flexible, anatomic chin implant that conservatively enhances the anterior projection of the chin in profile. The chin implant is placed through an incision hidden underneath the chin, an area where many people already have a scar from a fall in childhood.
Moderate enhancement of chin projection in appropriate patients can dramatically enhance the profile, in a manner that is completely natural-appearing. It is remarkable how increasing chin prominence in some patients will reduce the apparent prominence of the nose, and restore an overall sense of harmony and balance to facial features.

For enhancement of the cheek bone area, I rely exclusively on structural fat grafting. Careful and meticulous fat grafting not only avoids some of the potential complications of solid cheek implants, but it also allows more precise 'customization' of the aesthetic improvement that can be obtained for each individual patient. It is also my opinion that structural fat grafting produces a more natural-appearing enhancement of the cheek area than what is generally achieved through the placement of solid implants over the cheekbone.

To perform fat grafting successfully and reproducibly a surgeon must employ careful preoperative planning, appropriate instrumentation and meticulous surgical technique.  It is not something you can 'rush through' or spend just a few minutes on during a larger surgical procedure.  The unfortunate reality is that not everyone who performs fat grafting is willing to put in the level of education, training, investment in instrumentation and operative effort required to produce aesthetically ideal results.
One must also have an aesthetic vision for ideal and youthful-appearing facial fullness.   Just like traditional facelift surgery can be overdone or performed incorrectly to produce an unnaturally tight, pulled, 'windswept' look, fat grafting can be overdone to produce an excessively full and even bizarre postoperative appearance.  Too much fat grafted into any area (or any fat placed where it doesn't belong) looks unnatural.  It's analogous to breast augmentation results: if the surgeons selects an appropriate implant volume and positions the implants correctly, the patient gets a beautiful, natural-appearing breast enhancement.  If the surgeons stuffs a pair of 500cc implants behind the breasts of an average-sized patient, then that patient ends up with a cartoonish 'boob job'.  I think many of the unfavorable results in fat grafting are from the overzealous placement of excessive amounts of fat, which may have been the inevitable response to the recent paradigm shift in aesthetic facial surgery: away from the 'wind tunnel look', and towards the restoration of soft tissue volume.

Here is one patient’s experience with fat grafting posted to RealSelf:
Fat is great when used JUDICIOUSLY and CONSERVATIVELY, but too much of a good thing becomes a nightmare and deeply regrettable. Make sure your surgeon listens, draws up precise operative plans beforehand and makes plenty of time for you and your concerns. Do NOT take it lightly.

I couldn’t agree more with this patient’s response to her experience with fat grafting.  Just like breast implants, or liposuction, or browlifts, too much of a good thing is not at all a good thing.  And cosmetic surgery (and this includes the preparation for surgery) of any kind without attention to detail and a focus on natural-appearing results will leave patients feeling disappointed at best and feeling disfigured at worst.  Now regarding whether or not fat grafting is a surgically sound concept…
For transferred fat to truly qualify as a 'graft' the following must happen: living tissue must be transferred to a new location, and that tissue must gain a blood supply at the new location which provides oxygen and nutrients which allow it to persist indefinitely as living tissue.  We know that with appropriate instrumentation and technique this is achievable, so one of the opinions expressed in this thread that "most of the cells from fat injection are dead " is simply untrue (and structural fat grafting, to be clear, does not involve 'injection' of fat).  MRI studies have shown that with appropriate technique grafted fat persists long-term as living, vascularized tissue in the recipient site.

It is also well-established that adult human fatty tissue contains stem cells that have the capacity to repair damaged or injured tissues, and stem cells can be concentrated during the fat harvesting process.  This effect has applications in both cosmetic and reconstructive surgery.  Fat grafting is now being used, for example, as a means to stimulate the repair of chronic, non-healing wounds.  Several centers have reported on fat grafting immediately below non-healing chronic wounds resulting from radiation therapy for cancer, with rapid improvement and eventual healing of wounds for which no other wound treatment was successful.  The development of stem cell therapies involving the harvesting and processing of viable human fatty tissue is one of the hottest topics in both clinical and experimental medicine today.
When performed correctly fat grafting actually has the capacity to heal, revitalize and rejuvenate the local tissues at the recipient site.  I have treated a number of patients with facial fat atrophy following overly aggressive 'non-invasive' rejuvenation treatments including Thermage, Fraxel and IPL.  Most of these patients report not only an aesthetically  pleasing and permanent improvement in facial soft tissue volume, but also an improvement in the quality and vitality of their facial skin.

I perform extensive facial fat grafting during most of my facial rejuvenation procedures, and it is the very first thing I do - before making any incisions to lift the brows, eyelids, face or neck.  Fat grafting allows me to obtain results that are simply not possible with conventional, subtractive surgical techniques alone.  Patients frequently return for grafting of additional areas after their initial experience with strucutral fat grafting.  To characterize it as the pointless and potentially harmful placement of non-viable tissue is an opinion only, and it is an opinion with which quite a number of plastic surgeons who successfully rejuvenate faces (and breasts and bodies) with fat grafting would vehemently disagree, myself included.
Solid fat/fascia and fat dermis grafts are another means by which facial soft tissue volume may be significantly and permanently enhanced.  As with fat grafting, survival of the grafted tissue is variable and some of the graft material is reabsorbed.  As with fat grafting, potential complications such as infection and cyst formation are possible.  And as with fat grafting, appropriate preoperative planning and surgical technique are required in order to obtain ideal and lasting results.  In my opinion structural fat grafting is more versatile, as fat can be easily and rapidly added to any tissue plane (level); and it has the added benefit of the ‘stem cell effect’ which is difficult to quantify but unquestionably present in many cases.

Both structural fat grafting and fascia-fat (or dermis-fat) grafting can be competently performed (or not) by Board-certified plastic surgeons.  Neither should be trademarked or considered proprietary.
As with any surgical procedure take time researching your plastic surgeon. Schedule several consultation, view many photos from many patients, each from multiple perspectives (start by looking at photos on this website) and speak to former patients of any plastic surgeon you are considering.

Sculptra or Radiesse

Scupltra,  a biostimulator is an excellent choice for restoring lost volume to the face.  We know that volume loss is one of the most important contributors to aging and the collagen stimulation that Sculptra encourages gives a natural, soft result.

Radiesse is also an excellent choice for volumizing and the hyaluronic acid fillers are a good choice, especially if you are not sure if you are going to like the result, asthey can be reversed.

Increasing the size of your cheeks with fillers is an excellent alternative to cheek implants. The best volume filler is your own fat. This can be harvested from your stomach or buttock and washed. Then it is injected into the subcutaneous area of the cheek. It may be performed in the office or under sedation in the OR. Another good choice is Radiesse or Juviderm. The injection technique is slightly different, but a qualified Plastic Surgeon would be able to do this successfully. My advice, don't let the nurse injector do the procedure, have the MD perform the procedure. You will be happier with the results.

Good Luck!

The aging process tends to result in loss of fat in the cheeks and other areas of the face. To restore this requires a fair amount of of filler. Because of the extensive nature of this dermal fillers are really out of the question if you want any kind of long term correction.

Therefore your two choices are implants such as medpore or fat. Typically the skin gets thin as we age and implants can be difficult to camouflage. So I think micro fact grafting is your best option. A large amount of small fat product can be injected with good results.

Dr. Pearlman has given you a good review of the non autologous fillers. However the best and most natural filler is your own fat. It is harvested from your abdomen or your medial thighs or waist and then grafted into your face. It is a difficult procedure to learn with a steep learning curve so make sure your surgeon has had a lot of experience with the procedure. You may want to start with one of the more temporary fillers to see if that is the look you are looking for.

Dear Louise,

When considering the use of a filling agent I always consider the amount needed, how often it needs to be done, the long term effects and costs to the patient.

Of course fillers are the easiest way to go and require little down time. I would recommend a long lasting filler like Radiesse or Sculptra. You may also want to consider using your own fat even though this is a surgical procedure it has very little downtime and risk and can usually be done under local anesthesia.

Another option to consider is the use of a "submalar implant". This is a surgical procedure that involves placing an implant into the cheek through an incision inside the upper lip to restore the lost fullness. Even though this is a surgical procedure it is probably the longest lasting and will give the most natural result.

I think you should discuss these options with your doctor before deciding on a particular procedure.

Good Luck!

There are many great options for fillers in the cheeks. Products like Voluma and Restylane Lyft can work great in these areas to provide a long-lasting (but still temporary) result. They do a great job at supporting the tissues of the mid-face. 

Sculptra is another product that works well in the cheeks by stimulating your body to produce its own collagen in the area of the injection. Radiesse also works well, but is a calcium-based product that is made of different material than products like the Restylane and Juvederm families of hyaluronic acid fillers. The downside of Radiesse is that it cannot be reversed with hyaluronidase like the hyaluronic acid products can be if needed.

The cheeks are a very forgiving area as many products work well in the cheeks, but some products work better than others. I always recommend that patients seek treatment with a skilled and highly-trained injector for a personal consultation and individualized treatment plan.