Should I get a facial fat transfer or something less invasive? (Photo)

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Greetings Gregg,Thanks for the question and the helpful photos. You are a handsome guy but as with the best of us, the aging process does start to show as the face evolves. You have great brow projection, decent temple volume, but you biggest issue it relative skeletal and soft tissue (mostly fat) deflation of your midface (Lower lids and cheeks). Unfortunately no treatments are "permanent" as the face continues to age regardless of what we do however If you are looking for treatments that are longer lasting I think there are 2 options for you. 1) Facial fat grafting +/- lower eyelid fat repositioning blepharoplasty or 2) Sculptra.
The fat grafting has the benefit of using your own tissue and a very natural look when done well. Sculptra is a bio-stimulatory injectable treatment that triggers your body to build more collagen. Also looks more natural and is longer lasting than traditional hyaluronic acid filler. Can be done in office and takes an average of 3 sessions.
In my experience, both of these treatments take about 6 months to show their effect so patience is needed. Also, when done well, results from both are very natural looking and relatively long lasting. However, any complications such as nodules or contour irregularities can be very challenging to treat so I would strongly recommend going to a provider with a lot of experience in either of these treatments should you choose to proceed.Regards,
Dr David Samimi

It looks like you are a great candidate for facial fat transfer. It is also possible to get semi-permanent injections like Renuva. Renuva is a non-surgical cosmetic treatment that uses a proprietary blend of adipose-derived growth factors, collagens, and extracellular matrix to restore volume, correct contour irregularities, and stimulate tissue regeneration in areas of the body where fat has been lost or is deficient. It is often used as an alternative to dermal fillers, fat grafting, or other surgical procedures, and is typically injected under the skin in a series of small injections.

An “in person” exam is necessary to determine the best course of action.

I hope this helps,
best of luck !