Best Procedure for Gaunt Cheeks?

Gaunt cheeks are a real problem for many women with long, thin faces. Until the advent of volumizing agents in the last few years, little could be done. Surgery was limited at best in dealing with this condition. In addition to being an aggressive, invasive surgical procedure, a facelift had the potential for making things worse by giving rise to a cadaverous or skeleton-like look when skin got stretched over underlying bone. 

Replacing volume, or actually providing volume where nature never did, is the best approach to contouring gaunt cheeks. Fat injections were useful for dealing with the problem, but this required a two-step process of sucking fat from the hips, abdomen or buttocks, then processing it, and finally reinjecting it. This multi-step process was relatively expensive and involved making wounds on the body in addition to those at the actual treatment site. Duration of results was also variable and seldom permanent as had been hoped.

The introduction of volumizing materials, i.e. injectable products with sufficient viscosity to lift, contour and replace lost or absent volume, changed the nonsurgical esthetic landscape. Hyaluronic acid volumizers, such as Juvederm Ultra Plus and Perlane (and a whole variety of others available in Europe and Israel) and Radiesse, a calcium-based agent, can be used to reshape and recontour the face in a matter of minutes. Results may last between 8-16 months for the hyaluronic acids and between 12-18+ months for Radiesse.

There are many ways to augment cheek volume (and reduce hollowness).
On a temporary basis, hyaluronic acid fillers such as Juvederm or Restylane or similar products work well. At deep levels in the face, Sculptra also works well, although we don't use Sculptra in our practice because of lumpiness concerns.
Cheeklifts help the area below the eye and can adjust up cheek center mass. Cheekl implants, when cleverly placed, can also achieve very nice results in the malar and submalar regions.
In a patient with existing hollowness, if a facelift is performed, it is vital not to remove any volume from the face, as occurs with SMAS operations or deep plane operations. Rather, the deep tissues can be restructured, retaining and redistributing all the volume.
If you are interested in your very best result, for most patients at 55 this will come from a volume adjusting facelift plus material added to your cheeks. For this we prefer LiveFill, nontraumatized tissue from the patient's own tissues.