What to Do About Loss of Volume in Cheeks?

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.