Do Cheeks Stretch or Just Become Saggy?

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

Many surgeons believe that cheek laxity is due to fascial laxity and a discordance between facial volume loss and excess skin. Best, Dr. Karamanoukian

Thank you for your question. In general, normal facial aging entails both loss of cheek volume and cheek ptotis or sagging. The early appearance of mid-facial aging may be amenable to improvement with fillers alone to 'revolumize' this area. As mid-facial aging progresses, volume replacement alone may be insufficient to achieve optimal results and a lifting procedure may be considered. What has occurred in your particular case is not clear from your description. An in-person consultation with an experienced facial surgeon would likely be very helpful. Warm regards.

Most people think that the face age3s by getting loose and sagging. While there is some skin laxity that develops as we age, the majority of the signs of aging is from loss of volume.  As we age, we lose fat - this cause the face to deflate, and the cheeks or jowls look like they are sagging. If we examine photographs over time, we notice that marks on the skin such as moles and scars, do not change position. This means that there is no drooping or descent of the skin! Rather, it is deflation. The correction may involve surgical repositoning of the deep fat which is done during a facelift, or non-surgical injections fo filler to add volume. Understanding this idea of volume loss, is key to facial rejuvenation.

Every body has inherent asymmetries within it, so that no one body part is EXACTLY the same as its counterpart on the other side. Same goes for breast, eyes, arms, legs, and yes, cheeks. As we age, our faces lose volume, especially prominent over the malar region, or the cheek. Additionally, gravity pulls the soft tissues over the cheek bone to create that "soft tissue descent" and "malar hollowing". This can cause the jowls to become prominent and the nasolabial folds, or laugh lines, to become deeper and more pronounced. There are many non-operative and operative maneuvers to ameliorate this. A consultation with a Board-certified plastic surgeon is your first and best move. Good luck and fare well.

First lets discuss anatomy. The bony bulge under your lower lid is the malar eminence. There is a slight loss of fat over this prominence. Beneath the malar eminence is the submalar area and what we refer to as the cheek which is divided into 3 parts. This area loses the most volume as you age causing "submalar hollowing." Gravity also causes the cheek to move inferiorly (down) and anteriorly (forward) leading to deep nasolabial folds and jowls. A facelift can dramatically resolve many of these problems. There are many procedures that can improve the signs of aging. Make sure you are seen by a plastic surgeon who performs all of the procedures and is certified by the American Board of Plastic Surgery to get an honest opinion.

Actually they diminish in size from loss of volume. How many times have you seen someone at age twenty or so and said, "You'e lost our baby fat?" Well, the good new is that it looks great in the twenties, but the bad news is you continue to lose the fat, and it doesn't look as good in later years. As a youth, your cheek extends to the lower lid superiorly, the nose medially, your upper lip (or close to it) inferiorly and laterally is circular posteriorly. The most beautify cheeks are not necessarily the "high cheek bones" but those that are shaped like a simple disc. As you age, hollows and shaddows appear,which give your age away, e.g., the hollows under the eyes, the tear trough, mid-cheek hollow, etc. 

The question is, how do you restore the volume? Injections of our surgeon's choice can be Juvederm, Sculptra, Artefill, or fat. Fat injections are becoming more common now. A face lift may be in order if you have jowls and a saggy neck, but you still may need volumization with injectables.

Do Cheeks Stretch or Just Become Saggy? - YES.

Age is associated with loss of volume in the face (including the cheeks) resulting in deflation. It also results in some excess skin and in sagging resulting in the visible creases of the nose to corners of the mouth (nasolabial) and marionette ("drool") lines. Facial excercising will NOT add lost volume to the face NOR will it rejuvenate the skin. Depending on the amount of aging you may benefir from
- addition of volume to the face (fat grafting or addition of fillers such as Restylane/Perlane or Radiesse)
- laser skin resurfacing
- Face/ Neck Lift

All of the above. The cheeks do sag, stretch, and lose volume as we age. Ultimately, gravity does affect all of us. The asymmetry you describe is also normal. Treatment is individualized and may include a cheek lift, cheek implants, volume replacement with fat or fillers, and/or skin treatments such as laser resurfacing or chemical treatments and peels.