What can be done to address flatness around mid-cheek without filler? (photo)

Thank you for your question. What you are experiencing is early deflation of the deep fat pads of the face leading to shadowing and concavities. In most cases, dermal fillers or facial fat grafting are the preferred choices for adding volume to the midface and definition to the cheekbones. A dermal filler treatment is quick and does not require any anesthesia or downtime. The results should be apparent within about one week and will last for many months or even years in some cases. 
Facial fat grafting uses fat cells extracted from another area of the body like the abdomen or thighs. The fat is processed and prepared for injection into the face. Injections are done in a similar fashion to dermal fillers, but can last longer than fillers in most cases. Fat can also be less predictable, so make sure if you choose this treatment, your doctor is well-versed in the process. An experienced, board-certified dermatologist can assess you in person and help you choose the best treatment for you. 

I am curious as to why you don’t want to consider filler for this area as this is probably the best treatment to give you the added volume and definition you want. In the hands of a skilled, board-certified dermatologist, filler can be an excellent way to contour the midface without anesthesia or downtime. If you want a solution that lasts a bit longer, facial fat grafting may also be an option. This procedure takes fat tissue from one area of the body like the abdomen or hips and places it into the areas of the face in need of augmentation. The fat is injected in a similar fashion to a dermal filler but the results tend to last much longer. I encourage you to schedule a consultation with a board-certified dermatologist who can assess you in person and create a treatment plan that meets your needs and expectations best.