I have deep grooves, possibly festoons on my upper cheeks. What are my options? (photos)

Question

I have had these very deep lines and puffy patches of skin on my upper cheeks for my whole life, they seem to be getting more pronounced as I get older (I am 28). Is there anything I can do to reduce them, preferably non-surgically? I am not totally against surgery but I don't want to risk worsening them or appearing as though I've "had work done". I could live with them the way they are but I don't want them to get worse or start sagging later on in life. I already appear very tired all the time.

Sheila S. Nazarian, MD · Answer

Schedule a consultation with a board certified plastic surgeon in your area to be assessed in person and discuss fillers to address the under eye area, upper cheek and the transition between the two. My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Johnny Mao, MD, FACS · Answer

I would use Voluma, which is generally used for cheek augmentation to fill those deep grooves more laterally. You can expect 9-12 months duration and sometimes even longer.  For the medial lines or tear trough I would inject more finer fillers such as Restylane or Belotero because of the thin eyelid skin in that region to prevent surface irregularity.  Duration can be expected to be one year in that region.  For the surgical option, I would need to examine the whole face to determine if you have true mid face descent versus festoons; mid face lift approached thru an extended lower blepharoplasty approach would be an option.  Another surgical option would be fat transfer obtained from the abdomen/thigh and injected into the deep groove.

Evan Ransom, MD, FACS · Answer

Thank you for the photo and your question. This is a highly sensitive area and all treatment options have benefits and risks. I use fillers routinely in the midface and under eye area in patients around your age. For the tear trough, I generally use Restylane. Lower down on the cheek, where the line continues further toward the angle of the jaw, you have a "malar groove" this requires use of a thicker filler placed more deeply. I like Voluma or Restylane Lyft (f.k.a. Perlane) for this area. Best of luck!

Kenneth D. Steinsapir, MD · Answer

To not get so-called smooth fillers for this.  You need a filler like Restylane that holds where it has been placed.  Some of the fillers that are described as smooth migrate out of these types of lines.  Specifically do not get Juvederm for this.  I do not like Radiesse because it can't be erases or modified after the injection if there is an issue.  Do not get this product. Fillers do require some care and maintaince so finding a great injector close to home is best.  Surgeries of the are not ideal and fat grafts cause terrible scaring and harm the glide function of the top of the cheek.  Please be careful what you look for.

Joel E. Kopelman, MD, FACS · Answer

This is not a problem that surgery could fix. I agree with the other reviewers , judicious amounts of Restylane injections placed in both deep and superficial planes will remedy these problems.

I have deep grooves, possibly festoons on my upper cheeks. What are my options? (photos)

Answers (6)

Answer: These generally respond very well to aesthetically performed hyaluronic acid fillers.

Answer: These generally respond very well to aesthetically performed hyaluronic acid fillers.

Answer: Deep Grooves and Puffy Patches

Answer: Deep Grooves and Puffy Patches

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Everything you need to know about Eyelid Surgery

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I have deep grooves, possibly festoons on my upper cheeks. What are my options? (photos)

Answers (6)

Answer: These generally respond very well to aesthetically performed hyaluronic acid fillers.

Answer: These generally respond very well to aesthetically performed hyaluronic acid fillers.

Answer: Deep Grooves and Puffy Patches

Answer: Deep Grooves and Puffy Patches

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.