Best treatment to restore volume on cheeks after weight loss? (Photo)

Question

Hi, I am 34 years old and recently lost around 10lbs. My face aged a lot in this process and I'm now looking for a solution. I've had 3 vials of sculptra injected and I don't see any difference. What are other, better and more effective options to restore the fat in the lower cheeks? Thank you

James M. Economides, MD, FACS · Answer

It's understandable that you're looking for more effective solutions to restore the lost volume in your lower cheeks. While Sculptra is a popular option for collagen stimulation, results can take several months to become noticeable and may not provide the immediate fullness you’re seeking. Here are some alternative options that may give you more noticeable and faster results:

1. Dermal Fillers (Hyaluronic Acid-Based)
Juvederm Voluma, Restylane Lyft: These hyaluronic acid (HA) fillers provide immediate volume and are specifically designed to restore fullness in the cheeks. HA fillers are ideal if you're looking for a quicker, more noticeable improvement compared to Sculptra.
Benefits: Immediate results, can be customized for the level of volume you need, and can be dissolved if you're unhappy with the results.
Duration: HA fillers generally last between 12-18 months.
2. Fat Transfer (Fat Grafting)
How It Works: Fat is harvested from another part of your body (such as your abdomen or thighs) and injected into the face to restore lost volume.
Benefits: Since it's your own fat, the results are natural-looking and longer-lasting. This procedure can permanently restore volume if the fat takes well.
Considerations: The recovery is slightly longer compared to fillers, but the results can be very effective for individuals seeking natural, long-term volume restoration.
3. Radiesse (Calcium Hydroxylapatite)
How It Works: Radiesse is a dermal filler that not only adds volume but also stimulates collagen production over time. It’s thicker than HA fillers and can provide structural support to the lower face and cheeks.
Benefits: It offers more immediate volume with longer-lasting results (up to 18 months) compared to HA fillers.
Considerations: Radiesse is not reversible, so it's important to be confident in the treatment plan.

Jason Emer, MD · Answer

Thank you for your question Volume and contouring of the cheeks can be created with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra. Implants or fat are alternatives. Botox and radiofrequency can help slim and contour the jawline. Liposuction can help slim the face. Ultherapy, J Plasma(,plasma pen, microneedling/PRP) and rf treatments can provide skin tightening and lift. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

Thank you for your question and congratulations on your weight loss. Sculptra is a good choice for this area, but results are very gradual. If you continue to lose weight, you may see even less improvement as additional volume loss can occur. Another option might be a hyaluronic filler like Voluma, that is designed to add volume to areas like the midface. Facial fat grafting is a third choice and the one that will last the longest. I recommend scheduling a consultation with a board-certified plastic surgeon with extensive training in fillers and fat grafting. Through an in-person consultation, your doctor can create a customized treatment plan to meet your needs and goals best.

Nelson Lee Novick, MD · Answer

Injectable hyaluronic acid-based volumizing fillers, such as Voluma XC, Stylage XXL and Neauvia Intense Flux work well for re-volumizing and recontouring the lower cheeks and jawline. The results are seen at the time of treatment and typically engender an immediate "Wow!" reaction. I personally gave up using Sculptra quite a few years ago for a number of reasons, some of which are suggested by your question. The results are quite gradual and typically three treatment sessions, as in your case, are required to achieve the desired improvement, and the treatments are relatively expensive. If sufficient time has not passed since your last treatment session, it would be prudent to wait to see if you get any additional improvement. If after a few weeks, however, there is no change or insufficient improvement, you would be wise to consult with a board certified aesthetic physician and be sure to ask to see his/her personal before and after photos before agreeing to proceed. Finally, be cautious if offered fat injections for a number of reasons. First, they tend to be a relatively expensive proposition. Secondly, it is a two step minimally invasive process, where the fat is drawn from the tummy, hips or thighs and then reinjected with larger cannulas into the face. Thirdly, the fat once separated from its original blood supply often does not last as long as promised. And finally, whatever fat does survive retains the characteristics of the location from which it was drawn. Meaning that with aging, if your belly fat was meant to expand, the fat now in the face from the belly is likely to expand, as well.  Best of luck to you.

Michael I. Echavez, MD · Answer

There are a variety of fillers that can be used in the cheeks to restore volume.  You mentioned you have had 3 vials of Sculptra and have not noticed any difference.  Did you have all of those vials at one treatment session or over multiple treatment sessions?  Sculptra normally does work well but does require several treatment sessions spaced over time to give gradual but long lasting improvement.  Voluma is another filler that gives more immediate results than Scuptra but the results will not last as long as those seen with Sculptra.

Lisa S. Bunin, MD · Answer

Isn't it amazing how weight loss, which looks great on our bodies, can reek havoc on our face? I hear this concern from patients every day, and have the same issue on myself.  The issue in the lower cheek is that there is not a firm surface (like bone) to place filler on, unlike in the upper cheek. Sculptra works well in this area but is gradual and thus, if you are continuing to lose weight and are losing more volume you may not feel it is working as well as you hoped, but it is really that you are continuing to deflate from the weight loss.  Typically you would also notice more rapid loss of volume with an HA filler or other immediate filler.  Other tissue stimulators like PRP may work, and diluted Hydroxyapatite  can also stimulate collagen production in this area.  For more immediate results HA fillers work well, but you will deflate more quickly here than in other areas.  You have beautiful bone structure and are young, so I would be cautious with adding anything permanent because the rest of your face may not change along with this area, and as you gain or lose weight things will be out of balance. Seek out a facial expert physician for this area. Good luck to you! -- Dr. Lisa

Anteneh Roba, MD · Answer

You have a few options. You can try longer lasting HA fillers like voluma or try radiesse, belotero or fat transfer to face.

Hilton Becker, MD · Answer

I find that the most effective treatment for hollow cheeks is fat grafting.There have been many advances in fat grafting techniques that are resulting in improved results..

Robert T. Buchanan, MD (retired) · Answer

The problem with loss fo fill in the lower cheeks is that there is no bone against which one can place a heavy filler like Juvederm Voluma, which works by pushing the overlying tissues away from the bone. In the cheeks, the best filler is a lighter one like Vollure that is placed in the superficial fat compartment. Another option is fat grafting, which can be placed in the superficial compartment and is permanent. Make sure you see an expert in both.

Best treatment to restore volume on cheeks after weight loss? (Photo)

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