Cheek Dents Becoming More and More Pronounced?

Malar Bags, which may appear as "cheek dents," generally manifest toward the outside, upper portion of the cheek area. Multiple factors may contribute to their development, among them the natural volume deflation and sagging that comes with aging and drainage problems in the small lymphatic vessels in the region. Owing to the latter, anything that affects fluid dynamics, like allergic reactions, fatigue, excessive salt consumption, etc. may worsen the appearance.of malar bags.

While malar bags are generally difficult to treat, I have found that superficial placement and molding of small amounts of Belotero Balance, a hyaluronic acid filler, along the "dent" helps to elevate line and permit a more natural, rounded contour. The benefit of Belotero is that even when superficially injected, as typically needs to be done for this situation, it does not result in the Tyndall effect, a bluish discoloration of the skin due to light scatter often seen with other hyaluronic acid-based fillers when injected too high up in the skin.

Sometimes, the restoration of volume, using a volumizing filler, such as Juvederm Ultra Plus XC judiciously injected in a 3D Vectoring pattern on the sides of the eyes, helps to pull this area straighter lessening the appearance of the dents. To pre-assess the potential benefit of this approach, your physician may try pulling the skin upward and outward to see if there is improvement. If so, this technique alone, or in combination with the Belotero Balance directly into the dent, may give rise to gratifying aesthetic improvement. 

These areas you refer to as "cheek dents" are actually an anatomical finding known as malar bags.  Malar bags sit at the top, lateral portion of the cheek and are distinct from eyelid skin.  This finding is often worsened by fatigue, allergy, excess sodium intake, etc.  Malar bags become more obvious with the aging process when descent/deflation of the cheeks occurs.  Although there is no full-proof method of eliminating this change, sometimes deeper volume replacement is helpful (Sculptra), sometimes surgical elevation of the cheeks, and sometimes a combination of treatments provides benefit.

Plastic surgeons do not like to see these since we do not have any really good treatment for these. Fillers conservatively done may be your best choice.