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

From the limited photo, it does appear that you have flattening of the anterior cheeks.  If you are opposed to utilizing filler material, a great alternative would be fat transfer.  The cheek area tends to do very well with fat transfer and has a very high retention rate for the fat.  This is due to the fact that the cheek is a 3-D mass where the fat can be deposited in multiple layers, ensuring how fat survival rates.  Additionally (although not able to determine with the eye cover), if you have prominent tear trough lines, this can also be addressed with a lower blepharoplasty with release of the arcus marginalis to allow your lower lid fat fall down and fill into the tear trough.  This along with the fat transfer is a great way to rejuvenate the midface.  

While it’s difficult to determine from the single image you provided, it appears adding some fullness to your midface will bring the definition and improvement you want. You mention that you don’t want fillers - I would be curious to know your reason. Fillers are actually a very effective way to enhance the shape of the midface without anesthesia or downtime. There are different formulations that allow your doctor to tailor your treatment to your precise needs and goals. 
Another option for you might be facial fat grafting. This treatment extracts fat from one area of the body, such as the thighs or hips, and injects it into strategic areas of the face to produce the contour you want. Fat tends to be less predictable than fillers, so make sure your doctor has extensive experience with this procedure. A board-certified dermatologist should be able to customize your treatment to your exact concerns to produce an optimal outcome for you. 

Fat grafting can be a good option for restoring volume to the face and make it look more youthfully enhancing and improving features and contours such as the mid face which you seem like you could benefit from having yours enhanced. It will be best to consult a board certified facial plastic surgeon in person and discuss your goals and options after a physical examination.Hope this helps,Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

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. 

There are some different options for adding fullness to the cheek area. The first is filler. I know you mentioned that you are not interested in this method, but it is often the most effective way to get the definition you want without anesthesia or downtime. The results are temporary but can last up to two years depending on the filler used and how quickly your body absorbs it. 
The second option is facial fat grafting, which uses fat taken from another area of the body like the abdomen or thighs. This procedure requires a great deal of expertise and precision, as fat tends to be less predictable than fillers. The final option is surgical cheek implants, which are placed using incisions inside the mouth. The procedure is performed using local anesthesia and recovery is about one week. No matter which treatment you choose, make sure it is performed by a board-certified plastic surgeon with the qualifications to produce the best possible results for you. 

Thank you for the questions. The photo is limited and it would be helpful to see your eye and the rest of your anatomy to get a more complete picture. If you are not interested in filler, then you might be a candidate or a surgical procedure such as fat grafting. However, I am usually reticent to jump to fat first without trying filler first because if you do fat grafting and do not like the results, then it is very hard to remove, whereas with filler, if you do not like the results, you can dissolve the product or you an wait for it to go away.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

It is very limited information one can get from this photos about your condition! It looks that small amount of micro-nano-fat grafts would help to correct this flatness for a long time. However, it is not possible to see yours lower eyelids; it may happen that lower eyelid surgery should be considered as well. In person consultation with a board certified plastic surgeon with good reputation in facial fat grafting is recommended. Good luck.

I recognize you’re not interested in having fillers. That is however the best option and you should consider that when making your decision. Picking less effective treatment options is going to significantly limit the improvement and results. Fat transfer is good at giving diffuse overall volume but not nearly as good as giving precise volumes in small areas. Fillers on the other hand are perfect at giving precise  amounts of volume in Small areas. You could also do a better job at defining the exact anatomic location you want corrected. Based on your posting I’m not sure if you’re referring to the nasolabial fold or mid cheek hollowness.Midface volume does well with fat transfer I would say nasolabial fold’s not so well. Fat transfer is also prone to leaving and even contours close the eyes in the lower Eyelid tear trough area.Injecting your own plasma isn’t going to do much for you Other than waste your money.Fillers is the treatment of choice and will give the best results in the most predictable manner.   Fat is probably the second best option.find the right provider, listen to their advice and you’ll have the best chance of a good outcome.Best, Mats Hagstrom MD