What's the Best Way to Treat Sunken Cheeks?

Question

I have the gaunt, sunken look in my cheeks.  How can I improve this?  I would be open to surgical and nonsurgical options, I just want to look better.  Thanks, Jean.

Nelson Lee Novick, MD · Answer

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.

Jason Emer, MD · Answer

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

Larry S. Nichter, MD, MS, FACS · Answer

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.

Lorrie Klein, MD · Answer

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.

William Ting, MD · Answer

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.

Kaete A. Archer, MD · Answer

Unfortunately, as we age, the fat pads in our face shrink (lipoatrophy) causing a sunken, gaunt look.  The face is full fat pads and they are all subject to volume loss. Some early changes can be seen in the temples and the cheeks.  
There are several options for improving facial volume including implants, fillers, and fat grafting.  Implants and fat grafting are considered surgical and permanent options.  Fat grafting is a wonderful option for all over facial volume rejuvenation but can be less predictable than fillers and requires a surgical procedure. 
Fillers are temporary options.  There are many options that work well for improving volume in the face.  Surgeons usually have a few favorites depending on the area of the face.  There is also a filler available in the US called Sculptra Aesthetic which is great for overall facial volume - especially after weight loss.  The treatment is a solution that stimulates your body to make more collagen as the product degrades.  The collagen/volume that your body creates builds over about 3 months for a natural overall increase in volume that is long-lasting.  Sculptra usually requires a series of 3 injections, spaced about 4 weeks apart for the full effect.  
All of these options have advantages and disadvantages.  I recommend a consultation with a qualified surgeon to have an exam and discuss options in detail.

William Portuese, MD · Answer

Non-surgical cheek augmentation is performed with temporary fillers placed into the cheeks as an in -office procedure. Permanent augmentation is performed with cheek implants, which are composed of Silastic, are inserted through an intra-oral approach, directly over the bone, under a brief general anesthetic for a permanent augmentation. Cheek implants are manufactured in a large array of thicknesses, sizes, and shapes. For many examples, please see the link below to our cheek implant photo  gallery

W. Tracy Hankins, MD · Answer

Sculptra

	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.  The process is gradual so that even people who know you well won't think you look suddenly "different".

David C. Mabrie, MD · Answer

The challenge with cheek implants is they have a moderate amount of swelling involved with the recovery, they can have a moderately high complication rate including infection, movement, fluid development, nerve injury.  Once they are in, it is very difficult to modify them.

	Fillers on the other hand may be placed in the office, with very little discomfort and can be customized to every face.

	Knowing what I know from this side of the needle/ scalpel, I would choose fillers for myself in a second.  In fact I do choose fillers for my own chin, which takes about 5 minutes every 6 months.

	There are multiple fillers options which vary in consistency, and injector preference.  I like Restylane for most first-time patients, and Radiesse for cheek and chin in veteran patients.

	For more info on using Dermafillers to the cheeks, please click the link below!

Michael Law, MD · Answer

In my Raleigh, North Carolina Plastic Surgery Practice I use Fat Grafting to treat sunken cheeks. There are a number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume or have developed deep lines and creases. Probably the most popular fillers currently are hyaluronic acid products like Restylane, Perlane or Juvederm which can be used to plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). The improvement generally lasts about 6 months and can last up to a year. I regularly use Juvederm, Restylane and Perlane in my Raleigh, North Carolina plastic surgery practice to fill lines and plump lips

	For patients seeking permanent enhancement of soft tissue volume, the ideal material to use would obviously be something that is naturally-occurring and not rejected by the body or treated by the immune system as a foreign material. Whether the goal is to restore volume to an area such as the lips or the cheeks, or to fill in a crease or depression such as the nasolabial folds or marionette lines, the ideal material is quite clearly the material that one wishes was there in greater abundance in the first place: YOUR OWN FAT.

	A relatively new technique has been developed called structural fat grafting, in which 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.

	This is a procedure that 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.

What's the Best Way to Treat Sunken Cheeks?

Answers (13)

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