Flat cheeks, visible dents and uneven smile following RF treatments - Facelift, Fat graft, cheek lift or filler ? (Photos)

Question

I am 55 years old and unfortunately experienced significant facial fat loss after undergoing RF treatments a few years ago. This has left me with flat cheeks and visible dents, as well as a pulled or uneven smile caused by a dent above the smile line. In January 2025, I had hyaluronic acid filler placed (½ syringe on each side), which did help, but only to a limited extent. While I did notice some improvement, my cheeks are still quite flat and the dent affecting my smile remains. The filler seem to have now gone. I’m feeling unsure about what treatment options might work best in my situation and would really appreciate advice on how RF-related fat loss and smile distortion can be addressed safely and effectively. Thank you very much for your time and guidance.

Zoran Potparic, MD · Answer

Loss of fat tissue which you experienced does not have to be directly related to previous treatment but very likely it is a “natural component of aging”.Correction with fillers or better with fat grafting is a good option. Whether face/neck lift is needed as well can be decided only on the basis of in person or teleconference consultation. Good luck.

Waylon Zeng, MD · Answer

Hi there, thank you so much for your question. I'm sorry that you are dealing with long-term issues related to radio-frequency treatments. This can sometimes occur from thermal injury to the deeper tissue like the fat underneath the skin. As you may have noticed, HA filler does a great job at adding volume, but this is temporary so it will dissolve with time (or sometimes migrate depending on where it's placed). A more permanent intervention would involve either a face lift or fat transfer (grafting). 
I like to think of this as a sausage or water balloon. With age or fat loss (from weight loss or from RF treatment), there is often times more skin (think the sausage lining/balloon rubber) and lack of volume (think sausage filling/water in the balloon). If there is skin excess causing folds or jowls, then a facelift would be needed. Additionally, if there is sagging of the fat or soft tissue under the skin, a face lift can be done to reposition them. If there is loss of that sausage filling, then fat transfer would be beneficial.
That is a high-level understanding of the differences between the two procedures. It's hard to determine based on just the partial photos if a face lift would be needed, but volume loss/atrophy would best be treated with fat transfer to those areas. This can be in the form of microfat and nanofat (this does a great job at improving the texture of the skin and glow through the stem cells processed in the fat).

Ajaya Kashyap, MD · Answer

Thank you for your query. I am sorry you have had this unusual side effect of RF treatments. The fat loss, however, can be corrected with careful fat injections, with which I usually add some PRP as well. If, however, you feel that some age related skin sagging is present,  a facelift along with fat injections can be a good solution. Please find an experienced board certified Plastic Surgeon who can examine you and help you with all your concerns. All the best!

Darryl J. Blinski, MD · Answer

Based on your nicely post of photos, I would recommend a combination of treatments of a mini faced neck lift with muscle implication with either additional fat grafting or HA filler for syringes and combination expect fees to arrange from $10,000-$15,000. Best of virtual consult with for better explanations.

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