What is the best choice for improving cheek and chin volume? Implants, fat grafting, or injectable? (photos)

I am 35 and looking to enhance my cheeks and chin. I had Radiesse injected in both cheeks and in my chin and loved the look (1cc per cheek and 0.5 chin). But two years later, my cheeks have deflated back to normal. Can you tell me which way will provide a more permanent, natural look that will improve the proportions of my face between traditional implants and the newer fat-grafting? Or are neither of these preferable, and should I just stick to getting the injectables every couple years?

Doctor Answers 6

There are several options available to add volume, but fillers are the best option for predictability, and for adding if needed

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Thank you for your question. You’re 35-years-old and submitted several  very helpful photos and state you’ve had Radiesse injection in the cheeks and chin, indicating the volumes. You said you really liked the results, but 2 years later they deflated. You ask about other options such as surgical fat grafting, or if you should just stick with fillers.

I can give you my perspective on how I treat people like yourself who come into my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and the solutions for what you describe have evolved in this time. Now understand that when you ask this question, every doctor comes to the table with their own personal experience and bias, but I can share with you the basis for what I would recommend, and see if this makes sense to you before you decide if that’s the approach you want to take.

Prior to injectable fillers, there were facial implants and fat grafting. The advantage of facial implants like a cheek implant is it was being placed directly on the bone structure where there is a relative volume deficit, which I believe may be part of your situation. The challenge sometimes is with relatively thin skin and the shape of those implants. Sometimes people felt that they were too large, not the look they wanted, which is a potential drawback. When it comes to the area like the chin, it is fairly straightforward because chin augmentation with a facial implant is a very good approach for long-term benefit in this area, so it’s worth considering.

When it comes to fat grafting, it has improved as a method with the better understanding of the physiology of fat. However, fat grafting still remains unpredictable because no matter who does this type of procedure, there is always going to be a certain amount of fat that makes it, and a certain amount that does not.

I personally feel that for the type of look you’re trying to achieve, you’re probably better with something closer to the deeper structures, closer to the bone. With fillers like Radiesse which was placed probably just under the skin, you were happy with that result. I prefer newer hyaluronic acid fillers that are thicker and last for longer periods of time like Juvederm, and Voluma, which I place using a method called structural volumizing. This is a balanced,hybrid approach where you get the benefit of the principle of cheek implants or breast augmentation where you place something on the bone, but you get the reliability and the customization you can do with the filler. For your situation, I would go with structural volumizing with a filler like Juvederm Ultra Plus or Juvederm Voluma. You can get similar longevity of approximately 2 years, and in case you want a little more, you can come to the office, and in a few minutes, a little more can be placed. That type of customization is really great, and you’ve eliminated the unpredictability of fat, and also eliminated the surgical element of implants. These procedures for implants can still be within a short recovery period, but when it comes to thinking of predictability and customization, it is really wonderful to do structural volumizing. This is different from placing the filler under the skin where there is some benefit for you as you are very lean. t can be at the bone level between the bone and muscle, and then just below the skin level between the muscle and fat. In terms of facial structure, you might lose a little weight, or gain a little weight, so in that respect the fillers can be adjusted to compensate, or to not place as much.

You are starting with a good thing, and I would say injectables is the way to go. Understand there are different methods of doing these injectables, and I think structural volumizing is something worth exploring for you. I hope that was helpful, I wish you the best of luck and thank you for your question.

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Fat for me

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Fat grafting is the ideal filler technique for me.It is natural and the longest lasting of the filler products. 

Sculptra also works well for 2-3 years and is less 'surgical' if that might be what you prefer. 

Hope that helps. 

Adam Goodwin

Chin/Cheek Augmentation -- Fillers such as Radiesse, Voluma, Perlane; Fat; Implants; Sculptra

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For men you need an expert injector.  Fat, fillers, implants and sculptra can all be used.  you need a formal evaluation.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

Implants, fat grafting or fillers for cheek and chin volume?

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I would say the most permanent change you could achieve with the most amount of augmentation to the chin and cheeks would be with implants.  Fillers can work as well, as you have seen with the Radiesse that you have had.  Fat grafting could help as well, but I think implants or fillers can give more predictable results.  If you did decide to have implants, I would recommend submalar implants for your face and an implant for the chin.  Your other option would be to try and use a longer lasting filler, such as Voluma, Sculptra or Bellafill.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Cheek implants and a Chin implant

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Cheek implants are placed for patients who have a flat maxilla and the flat cheek profile and offer an augmentation to the midface area.  Chin implants are placed to augment the chin forward and also give lateral width.  Chin implants are placed for patients with a weak and  recessive chin profile to help with facial balance and portions.  Both chin and cheek implants are composed of Silastic and are usually placed under either local or general anesthesia as an outpatient surgical procedure.  Both cheek and chin implants are manufactured in large array of sizes and shapes which is best determined at time of the consultation and examination.  In our practice we use Implantech brand of chin and cheek implants for the last 25 years with an excellent success rate.  For more information, diagrams of the implants and many before and after results of both chin and cheek implants, please see the video and the link below 

Best choice for improving cheek and chin volume? Implants, fat grafting, or injectable?

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 Hi, I have performed many facial shaping procedures over the past 30 years, using dermal fillers and/or facial implants (cheek implants, chin implants).  Fat transfer or injections are far less reliable at providing consistent volume and shaping than an "off the shelf" dermal filler or facial implants that provide consistent, permanent enhancement.  For that reason, I do not use fat  for facial shaping.   Based upon the beauty principles outlined in my book on face and body beauty, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.  From the photos, your cheeks are flat anteriorly (in the front), the chin is weak as are the mandibular angles.  This combines to create an elongated oval shaped face.  The following procedures would create a more ruggedly handsome face.
  • Cheek augmentation with cheek implants to add angularity to the cheeks and mid face.  
  • Chin augmentation, using a chin implant, to add projection to the chin creating harmony and balance to the lower face.  I have performed many Chin Augmentations using chin implants for over 30 years.  From the photos, your chin is weak.  A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  
  • Augmentation of the mandibular angles using a dermal filler (jaw implants have too many unwanted side effects IMHO) to add volume, angularity and flare to the jaw line.
Hope this helps.

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