Best Procedure for Gaunt Cheeks?

I am 55, and have always been on the tall, thin side. I am healthy and into sports. My issue is that I have high cheekbones but the middle of my face all the way down to my chin is deflated (think Abe Lincoln!) I would love to get some fullness back.

Doctor Answers 18

Fat Injections vs. Cheek Implants

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Structural fat grafting can also be utilized in patients undergoing a midface lift, if additional enhancement of the lateral aspect of the cheekbones is desired. The midface lift and structural fat grafting, alone or in combination, allow me to restore or create youthful cheek and lower lid contours, without the need for cheek implants.

Aside from the associated risks of migration, infection, and bone resorption, I feel that cheek implants tend to produce results that are not natural-appearing, and for that reason I do not use them in any facial rejuvenation procedures.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Cheek Augmentation

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There are several options for augmenting your cheeks:

  1. Micro-Fat grafting - Long lasting, more expensive*
  2. Mid-Face Lift - Long lasting, more expensive
  3. Cheek Implants - Long lasting, more expensive
  4. Restylane, Juvederm or Perlane - Lasts about 12 months, less expensive, better for augmentation of the cheek, tear trough and peri-orbital tissues*
  5. Radiesse - Lasts about 24 months, less expensive, firmer than hyaluronic acid fillers, not ideal in the soft tissues around the eye
  6. Sculptra - Lasts about 36 months, less expensive, can cause "sculptomas" not ideal in the soft tissues around the eye

*I prefer micro-fat grafting for a long-lasting cheek augmentation and hyaluronic acid fillers for augmentations lasting 1 to 2 years. You should discuss the advantages, disadvantages, risks and benefits of these with your plastic surgeon.

I also recommend that your seek consultation with a Board Certified Plastic Surgeon for this type of mid-face augmentation. They understand all the options available to you and the surgical anatomy of this area.

You do have a few options.

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Sculptra is FDA-approved for facial lipoatrophy in HIV disease, but there is no reason why it cannot be used for people who need filler for the cheeks. Another filler that works well in the cheeks is Radiesse.

FAMI or Fat Grafting Autoinjections has the potential to be a longer-term solution in which fat is harvested by liposuction from a donor site and injected into or adjacent to the muscle of a recipient site. Up to 50% of fat that is transferred using FAMI actually engrafts and persists. FAMI should be done using regular tumescent liposuction, not "Smart" lipo.

Hope this helps.

Bryan K. Chen, MD
San Diego Dermatologist

Sunken cheeks

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This can be a challenging problem. I have two solutions to offer. First, a filler, though temporary is a good help. I use juvederm and get a good response for 6-12 months. Beware of silicone or silicone products which are illegal and cause eventual problems. The second solution in a small preauriculr facelift ( in front of the ear ) which will help lift the skin up and out of the hollow. Both together often  get a nice result.

Hollow cheeks in a 55-year old

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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.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Sculptra works for hollow cheeks

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Poly-L-lactic acid, available cosmetically under the name Sculptra, is best for treating overall facial wasting that occurs with age due to loss of fat and other supporting tissue. Poly-L-lactic acid is made of the same materials as dissolvable sutures.

It's an interesting product because while Poly-L-lactic acid itself fills, its presence also motivates the body to produce collagen encasing substance, similar to seeding a pearl. The body slowly digests the stimulus and only the new collagen remains. And the nice thing is, except for some possible bruising and swelling initially, there's really no down time to this quick fix treatment.

Two to four applications spaced over four to six-week intervals are normally needed to get poly-L-lactic acid's full effect. The fresh fibers are subject to the same breakdown process as other body collagen and, therefore, last about two years.

Several options

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Fat grafting is an option, but smart lipo will kill fat cells, and therefore not an option for harvesting viable fat.

Sculptra is another option. It is approved for use in AIDS patients who develop hollow cheeks as a result of treatment or the disease. This is expensive, may require several syringes at a time, and will last about 2 years.

Another possible option is a face lift. If you have jowls and pronounced nasolabial folds, this may be an option to think about. You must have enough tissue to move back into place however.

Several facial filler options for hollow cheeks

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First, there are several facial fillers that can be used. Sculptra is one which can rquire multiple treatments and supposedly offer a 1-2 year improvment in appearance. Radiesse and hyaluronic acid fillers ( juvederm and restylane) can also improve some hollowing as well. Autologous fat injections may also help. Smart Lipo or regular Lipo is only used to remove fat, so I wouldn't offer that to you if your cheeks are hollow. Lipostructure and fat grafting are the same thing.

Very good technique

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In my hands the best filler for the midface is fat grafting. There are different names for this procedure, it is very technical that requires knowldge of the anatomy. This is not a simple injection. Sculptra is FDA aaproved for HIV related lipo-atrophy.

It would be an option if you do not want to use your own fat or have liposuction. Most of my patients find it very useful to have lipo in the same time. Hope that helps.

Many options for cheek volume

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There are many great options for adding volume to the cheeks today. You have mentioned fat grafting which is an excellent option but does require a surgical procedure. This requires liposuction from the abdomen, flanks or legs. The fat cells are then processed and transplanted into the cheek. You can not use smart lipo to harvest the fat because the light energy destroys the fat cells you want to transplant. Besides recent review by our society demonstrates smart lipo is no more effective than current techniques.
As some of the fat dies on transfer the possibility of requiring further surgery always exists. Fillers are a simple office based procedure to give excellent immediate results. The options are Sculptra, Perlane, Juvederm, Evolence and Radiesse to mention the dominant fillers on the market. All are temporary with varying lenght of duration. This is in fact a positive attribute as the face changes with age and permanent fillers can create contour irregularities over time.
Sculptra is an excellent filler which is FDA approved for HIV positive facial wasting. Once a product is approved by the FDA and deemed safe it can be used for like indications but is considered off label use. Many of the applications of botox are actually off label. Scultpra will require a few treatments over time but the product will last 18 months. I am very pleased with the results I get with Sculptra, and so are my patients.
Perlane and juvederm are hyaluronic acids which is a natural component of human skin and they will last 6-8 months. If you don't like them they can be dissolved with a simple injection of an enzyme.
Evolence is a relatively new filler introduced about 4 months ago. it is a collagen product which is expected to last about a year. Radiesse is a mineral based filler in a gel carrier which works nicely in th cheek but also lasts about a year. Ask your surgeon to review the options. With an experienced surgeon you will be amazed at the improvements which can be made in your face.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.