What's the Best Way to Treat Sunken Cheeks?

Loss of the cheek fat pads with the years, as well as the downward migration of whatever remains of these pads, contributes indirectly to the development of many of the facial changes we commonly describe as facial aging. In addition to the obvious, sunken and flattened cheeks, these include the hollows, dark circles, crinkles and bags under the eyes, pronounced smile lines and marionette lines, and even the jowls along the jawline.

Because of the central role that the cheeks play in a youthful appearance, re-volumizing (i.e. reinflating) them with injectable contouring agents can not only restore their youthful shape, the "blush of youth,"  but improve the surrounding regions, such as under the eyes or the smile line area, as well, giving the face a kind of "minilift.'  In many cases, restoring the rounded contours of youth is the first step in a "nonsurgical facelift," and in many cases the lift is sufficient to reduce the amount of material needed to treat others areas, such as the smile lines or under the eyes.

Radiesse, because it is a more robust material than hyaluronic acid products, and tends to last longer, is my material of choice for sunken cheeks, although thicker hyaluronic acid agents, like Juvederm UltraPlus and Perlane may also be used successfully and may even be combines with the Radiesse. 

Thank you for your question. Facial sculpting and contouring can be created with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra, which would give improvement in facial balance. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Fat Transfer Results Are Long Lasting and a great option for correcting sunken cheeks.
Fat Cells that survive the transfer process continue to live like other fat cells. Therefore, the results are long lasting. The problem is not all transferred fat survives the process. In the face more than 75% may survive and more than 60% in the buttocks.. Of most interest is that the fat that does survive behaves as if it was still in the donor site. Therefore as the surrounding native fat tends to atrophy the transferred fat will not. Over time you will notice that the area may not be as full as it once was, but more than likely it is because of the native fat atrophy rather than the transferred fat.
Fat Grafting Results Permanent improvement in most cases. Micro fat grafting, also called structural fat grafting involves multiple injections of very small amounts  of fat injected in a series of discrete layers to allow for better revascularization and "take", gradually increasing the volume of  new soft tissue. My experience is that it is a great minimally invasive procedure for cheek augmentation.
Fat Cells that survive this transfer process continue to live like other fat cells. Therefore the results are long lasting. The problem is not all transferred fat survives the process. In the face for example it has been estimated that up to 60%  or more will survive in the cheek region. Of most interest is that the fat that does survive behaves as if it was still in the donor site. Therefore as the surrounding native fat tends to atrophy the transferred fat will not. Over time you will notice that the area may not be as full as it once was, but more than likely it is because of the native fat atrophy rather than the transferred fat.

Sunken and flat cheeks can br lifted and rounded with injectable fillers. Radiesse is one of my favorite fillers for cheeks because it is very robust, has a large amount of product per syringe, lasts longer than the hyaluronic fillers and gives immediate results.

Loss of volume along the cheeks will bring about sagging as the skin has less support to counter the force of gravity as well as shadowing due to the sunken nature of your cheeks. Replenish the volume will substantially bring about a rejuvenated complexion by re-inflating your cheeks. Quick fix can be achieved with soft tissue fillers such as Radiesse which is made of calcium, providing scaffolds for further collagen formation. Best long-term solution, however, would be Sculptra, which is FDA-approved for this purpose, to be performed over 3-4 sessions about 4-6 weeks apart as the results can last between 18 to 30 months.