Cheek Filler or Mid Face Lift?

I am 31 years old. I have extremely hollow flat cheeks, hollow eyes, and now pre jowls and lots of new lines forming and dents on chin. My skin is very much lacking elasticity as it feels loose and no firmness. All of this happenend within 1 year (ever since I turned 30). I believe I have prematurely aged (8 to 10) years sooner than normal as I have been a smoker. I am extremely depressed about these changes. I used to have a heart shape face and now it looks long & flat, pre jowls. Help?

Doctor Answers 34

The Tear Trough Triad: Mid face lift not fillers

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The approach to the lower eyelid and cheek (midface) is a very controversial and sometimes intimidating area of the face, and as you can see from most answers the majority of plastic surgeons want to perform fillers in this area which is fine though when looking at your face and your complaint, you have the typical negative vector orbit with a flat midface and early descent of your soft tissue. Fillers are only going to partially correct this, so I would recommend consulting a midface specialist who would lift your cheek and smooth out your lower eyelid, as well as add volume to this area. I perform this either through the lower eyelid or with an endoscope through the brow. It can be a technically challenging procedure though long term would likely address your concerns. Let me know if you have questions.

Get beautiful cheek bones with fillers!

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You are a beautiful woman Deni, even with the slightly flat cheeks! Look at those gorgeous eyes and lips!

I think augmenting your cheeks is appropriate, and I would recommend cheek filler injections. Radiesse might work the best, but Perlane or Juvederm  should be just as good, and they are reversible if you don't like the results. If you like the filler results, which you probably will, eventually I would consider cheek implants. They can balance your bone structure beautifully, and if for whatever reason in the future you don't like them, or they don't match your face any more, you can remove or replace them. With the fat injections, it is impossible to do. Most importantly, work on quitting smoking. It will serve you well in the long run!

Dr. Stella

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Fat grafting is an option to fill cheeks

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First, congratulations on quitting smoking. You are correct that smoking can prematurely age the skin.  Voluma is a new, long lasting, but temporary filler for enhancing cheek volume. 
Structural fat grafting is a powerful tool for correcting one of the primary processes of facial aging: the gradual loss of facial soft tissue volume, which primarily represents the atrophy of facial fatty tissue. The importance of restoring facial fullness cannot be emphasized enough, for without it, very few facial cosmetic surgical procedures are truly rejuvenating. As we age the skeletal features of the face become more obvious, and create subtle visual clues that tell the observer 'this is an older person'. Fat atrophy is often very obvious when it appears as hollowness in the temple area and as flattening of formerly full cheeks, but can also exist as more subtle changes that still convey an appearance of advancing age, such as the development of a hollow in the space between the upper lid and eyebrow, or as indentations in a formerly smooth and gently curving jawline.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Shaping the face with fillers has less injury and quicker recovery than mid-face lift

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There are three reasons fillers are the best way to treat your concerns of eye hollows, sagging cheeks, and a loss of your heart-shaped face. 

1. Avoid the injury and trauma of surgery. This is big, you avoid 7- 10 days of swelling and the risk of scarring and injury to nerves and the skin. Using injectable fillers requires very little down-time. Most patients have minimal reaction to the injection and can go about their day without any trouble.

2. Flexible, adaptable changes. Working with dermal fillers allows your practitioner to customize the areas of injection, the level of "plumpness" you achieve, and can make small adjustments at any time. You and your physician can modify your changes together, making them perfect. Once a surgery is done, there are no changes that can easily be made.

3. Natural Results.  By adding volume to the face your are able to directly treat what has likely happened over time, which is a loss of fat volume. By rejuvenating and filling in upper facial areas, the skin that has sunk down will slightly rise up again over the new fullness and will decrease the "sagging" that happens with age.

If you are concerned with long term results, remember, no treatments are permanent as you continue to age and your face slowly continues to change.  There are long lasting fillers like ArteFill available if you are interested.


Good luck!

For more info on facial Dermafillers, please click the link below.

Fillers vs facelift vs implants

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Certainly these are all viable options for cheek pad descent and central facial aging.  There are several advantages and disadvantages to each form of correction and to some degree they all would work.  Facial fillers are the most temporary solution but also reversible.  They are the cheapest solution initially but since they only last about a year with repeated treatments they can become expensive.  In general it takes a lot of filler to see a difference.  Cheek implants are a more permanent form of soft tissue augmentation but involve a surgical procedure to place the implant.  Any implant can get infected or malpositioned.  Finally a mid facelift repositions the normal fat pad back over the cheek bone this may drop again with time but generally last about 10 years.  Before and after photos as well as a 3-D animation of the the procedure can be viewed at my website

You have several good options for volume restoration in the face

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Don't be too depressed, as you have several good options for facial volumizing and some degree of skin rejuvenation. I would strongly recommend cessation of smoking first to optimize results. Fat transfer can be performed and results may be improved by adding a blood component call Selphyl at the same time. Selphyl uses your own blood platelets to add growth factors to the fat injections. Another alternative is a series of Sculptra injections for volumizing and skin rejuvenation. I don't feel you need a cheek lift or implants at this point. Consult with a reputable board certified facial plastic surgeon who is knowledgeable in these treatments. For temporary improvement you can try fillers if you prefer.

Use a filler not lift for younger patient

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In a younger patient such as you, volume restoration is almost always the first place to start, and a lift is more often appropriate for someone with more skin laxity. You could start with fillers such as Restylane, Radiesse, or Juvederm, but my suggestion would be a fat graft since it will be longer lasting. This could be done under local anesthesia and if done well should look very natural.

Cheek filler or surgery? indications

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what procedure is indicated for cheek.

in young patients we favor treatment with filler. filler can be hyaluronic acid or fat.

this treat deflated cheek and improve major creases like nasolabial folds and tear through deformity

in young people they rarely have a lot of skin aging and excess and ptosis.

in older patients there is hollowing around the eyes and more ptosis ( descent ) of the upper cheek. the mid facelift at that stage is more efficient than only fillers.

Jacques Haddad, MD
Montreal Plastic Surgeon

Cheek Filler or Mid Face Lift

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Thank you for the picture it makes commenting much more personal. I would suggest that you not have surgery at this time and try something non invasive to see if you like the result. I would use Radiesse in your cheeks and believe you would see an excellent elevation of your cheeks and that this would translate into your perception of your face being transformed back to a heart shape. If you like the results you can then have some fat grafting done for a more permanent correction. Of course the cessation of smoking will only add to your skin quality.

Facial aging

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Deni: In analyzing your anterior (front) view, I agree that you have lost volume in the midface. Patients usually complain about "circles" under their lower eyelids, the so-called "tear trough", which actually extends obliquely and inferiorly, bisecting the cheek.  What this represents is the appearance of the facial skeleton, as the facial fat pads either thin out, descend or displace.  Before the introduction of hyaluronic acid, poly L-lactic acid, calcium hydroxylapatite fillers, etc. "mid-cheek lifts" with Coapt fixation devices were among some of the so-called "solutions" to elevate the mid-face.  However, young isn't solely a function of being  tight and high.  A well balanced face has multiple layers, which in toto confer attractiveness.  The external layer of skin should have even tone, lack of sun spots, fine lines and coarse pores.  You are fixated on the "middle layer" of facial fat, which has literally "melted" away, a condition called lipoatrophy.  The flatness of your cheeks is a consequence of loss of fat.  Fillers are probably your best option, at your age. 

The lower third of your face is dominated by the "dents" adjacent to the chin.  You seem to hold a lot of tension in the chin and surrounding muscles.  I would advocate using a combination of hyaluronic acid fillers and neuromuscular toxins here to both relax the tension as well as boost the dents.  Find a physician who has both the interest as well as aptitude to help you.  Try to quit the cigs too!  Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.