Deep Upper Cheek Dents - Fillers or Facelift?

I reviewed the photo you posted. You have upper cheek grooves that are fairly common. These respond well to Injectable Fillers. My personal preference is Silikon-1000 for permanent results. 

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, 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 upward and straighten the area immediately below and medial to it lessening the overall 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.

Additionally, I have found that superficial placement and molding into place 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.

I have generally found that this combination approach of superficial filler, particularly Belotero Balance, injected directly into the dent, and 3D Vectoring Lift of the crow's feet area to produce the most gratifying aesthetic improvement for cheek dents..

Malar mounds are indicative of midface or cheek aging where the lower border of your eyelid muscle is revealed as the cheek pad falls off of it. This may be secondary to lengthening of the structures that hold these structures in place. It is interesting to read the responses to your question where most responders want to fill this area! The reason being this is a nebulous and confusing region for most practitioners including plastic surgeons and facial plastic surgeons who have difficulty handling this region surgically. The treatment I would recommend would be surgical and not non-invasive if you could tolerate the down-time. It would involve lift ing the cheek and tightening the lower eyelid muscle through the lower eyelid or with an endoscope. This is referred to a mid-face lift or cheek lift. Practically speaking it would be replacing these structure to their proper position not just adding volume to the area. The longevity of surgically repairing this area is more and likely less expensive over a period of time.

I hope this helps.

Dr. Trussler

Agree with the comments of my colleagues. Restylane, Perlane, Juvederm should do nicely here but must be injected carefully. Radiesse is another option that works well for cheek augmentation. However, it needs to be placed more deeply than HA fillers and would likely have less effect on your problem area.Stephen Weber MD, FACS

Temporary fillers are an excellent first choice to fill in creases due to the early signs of facial aging. The photo you have provided shows mid-Cheek groves which develop with mid face decent. Fillers are a non-surgical means of softening these creases with minimal down time. Juvederm or Restylane work equally well. The results should last about a year. The procedure can be done in the office with topical anesthesia. Some bruising may occur.

Another alternative is a mid face or a cheek lift. A photo of your entire face would be helpful to determine how much you would benefit from these procedures. If you have jowls or fullness in the lower part of you face, this may be a better long-term option.

I would recommend a consultation with a Board-Certified Plastic surgeon. Best regards, Andrew Lyos MD, FACS