What to Do About Loss of Volume in Cheeks?

Several cosmetic options are available to improve volume loss in the cheeks or midface. Volume loss is a natural progression seen with facial aging. Midface volume loss may also be seen earlier with genetic predisposition, medical conditions, severe weight changes, or medications too.

Treatment obviously is to add volume, typically. Injectable fillers with hyaluronic acid, Restylane, or Juvederm may be appropriate. Alternatively, longer acting facial fillers such as Radiesse or Sculptra provide longer-term improvement of the cheeks. All these injections are office procedures. A newer procedure, inappropriately labeled vampire facelift, is to inject your own blood back into the cheeks. This blood injection is a newer procedure without long-term experience by plastic surgeons.

Other options include fat injections, which have been used for decades for facial rejuvenation. Lastly, cosmetic surgery with a silicone implant or midface lift may be more appropriate in selected patients.

There isn't one best treatment for facial plastic surgery procedures. Only after a comprehensive evaluation by a plastic surgeon specialist can he/she help determine appropriate options for you.

For many patients, gravitational effects result in sagging of the cheek fat toward the jawline, creating a loss of volume in the cheek area.  If this is the case, then a MACS lift, which is a short-incision facelift, with internal repositioning of the facial tissues can restore volume in a very rejuvenating manner.

 Another cause of loss of volume is facial atrophy, which can occur with aging or weight-loss.  In this situation, it is usually better to add more volume by facial fat grafting (or transplantation).  New techniques for fat grafting are very promising with water-assisted liposuction (body-jet, WAL) for fat harvesting which provides for healthier cells with better and longer lasting results.  Facial fillers, or "liquid facelift", such as Radiesse, Juvederm and Sculptra are only going to provide small volume increases most effectively over facial structures such as over the cheekbones.  My preference in facial fillers would be Radiesse since it provides better volume, lasts longer and is more cost effective than some of the other fillers.  It is always wise to seek out a board certified plastic surgeon with experience in facial aesthetic surgery.  They would be able to help you with your particular goals, and perhaps a combination of above procedures would be optimal.  

Soft tissue fillers (e.g. Restylane/Perlane, Juvederm) can be used for cheeks volume augmentation with great results

There are many options for treating lost cheek volume, but probably the safest and that which has the highest satisfaction rate would be the use of injectable fillers such as restylane, perlane, juvederm or radiesse. These can all work quite well to give 1+ years of improvement, and have minimal if any downtime and minimal discomfort.

The best volumetric augmentation of the cheeks is with a small cheek implant. This will give a very consistent surgical result. You must have a flat cheek profile or submalar area for implantation to be appropriate. I do not recommend fat injections because of the inconsistency of the results.  

There are a lot of options for augmentation of cheek volume. Ultimately the goal is to restore youthfulness and achieve an aesthetically pleasing cheek contour. Essentially as we age the “midface” will sag and the eyes will become more elongated and worn in and appearance of aging to the cheeks and eyes ensues. The tear trough deformity also becomes more apparent.

Simple treatments include standard Restylane or Juvéderm, Perlane and Radiesse injections into the cheeks. These can have quick and easy improvement in volume of the cheeks. The downside is that these injections are not permanent. They last six months to a year. A high percentage of individuals elect to have improvement in this manner. The next option is for permanent augmentation, specifically fat injections can provide excellent improvement to the cheeks. This is a little bit more costly, but tends to be quite permanent and your own fat is utilized.

Facelifting can provide augmentation of the cheeks and restore the youthfulness of the facial problems related to aging face. Finally, cheek implants have been a time tested rejuvenation method for the cheeks.

The best answer for augmentation and restoration of volume in the cheeks depends on the individuals disposition. Simple and easy therapy dictates Restylane, Juvéderm, etc. More permanent but simple options include the less invasive fat injections or Sculptra, however permanent surgical answers then require surgery. I generally feel that simple answers are best first and more rigorous and permanent answers can be tried later. So Radiesse is a easy, simple first option.
 

There are 2 excellent options for volume replacement in the cheeks, Sculptra and fat transplantation.  Sculptra, poly-L-Lactic acid, is an injectable which restores volume by causing your body to produce collagen.  It typically lasts about 2 years.  Fat transplantations requires harvesting fat from another site and injections can have lasting effects, however some patients do not experience lasting results.  It is best to be evaluated by a board certified dermatologist or plastic surgeon for the best treatment for you.

Without seeing your individual needs, I recommend you consider all alternatives. Fillers such as Radiesse, Sculptra, and the patient's own fat all have advantages and disadvantages. Cheek implants and various techniques of brow lifting, with or without fillers, may be provide the best results. Consult with a physician who uses all these approaches..

Currently, I believe that the best treatment for the cheek area is injection with a filling material such as hyaluronic acid/Juvederm. I like Juvederm for this region since it is long-lasting (1-2 years) but does eventually go away in the event that you do not like the outcome. At the least, it is a good first step. See a board certified plastic surgeon who can go more in-depth with you reagrding your options based on your desires and facial structure.

Loss of volume is a common problem, often seen with aging.  There are a variety of treatments to counter this volume loss, most of which involve injecting something into the hollow areas.  The most common treatment is the placement of fillers into the cheeks.  Some of the most commonly used fillers are Restylane, Perlane, Juvederm, and Radiesse.  These are appealing because they are easy to place but are not permanent, lasting 6 to 12 months, depending on the filler.  An alternative is to remove fat from somewhere else in the body (hips, abdomen) and place it in the cheek.  This is a more involved procedure but can be permanent in some patients.

Hope this helps.