27, F – Midface volume loss or structural deficiency? Non-surgical vs surgical options? (Photos)

Question

27F (France, open to travel). Before/after photos attached (2020–2021 vs 2026). Concerns: • Reduced lateral cheek fullness • Less midface support • More visible smile crease • Skin feels thinner and more lax Earlier this year I had HA filler: • 0.5 ml per tear trough (inner corner only) • 1 ml per cheek (3 ml total) Result was subtle. Cheeks look slightly more structured but no true lift. From semi-profile, cheek filler seems to accentuate the central/lateral under-eye hollow (not the inner tear trough, which improved). So I see two separate areas: midface structure vs under-eye hollow. I do not want direct filler in the true under-eye/dark circle area. Only the inner tear trough was treated. I’m trying to determine whether this is mainly: • Volume loss • Early laxity • Or limited forward projection / mild negative orbital vector My structure was never highly projected, but it looked fuller and better supported a few years ago. Ideally I want to: • Improve deeper structural support (not just add superficial volume) • Reduce the smile crease • Improve skin density • Achieve a subtle lifted look Would additional structural filler or biostimulation be appropriate? Would fat grafting, mini midface lift, implants, or lower blepharoplasty be relevant in this case?

Anna Chacon, MD, FAAD · Answer

Thank you for providing such detailed history and photos — it really helps in understanding your concerns. From what you’ve described and the images you shared, a few key points stand out:

Volume loss vs structural support: You have subtle midface volume loss and reduced forward projection, which makes the cheek appear flatter and accentuates under-eye hollows. This is very common in your late 20s and early 30s, particularly if you naturally had a less projected midface to begin with.

Skin quality: Thinning skin and mild laxity contribute to the appearance of smile creases and subtle sagging.

Results from previous HA filler: Your prior filler improved the inner tear trough and provided mild cheek structure but did not lift or improve the lateral midface enough, which suggests the deeper structural support is still lacking.

Non-surgical options to consider:

Structural or deep filler: Using deeper filler in the zygomatic arch, lateral cheek, and malar area can provide lift and restore midface projection, indirectly softening smile lines.

Biostimulatory agents (Sculptra, Radiesse): These can improve collagen, skin density, and long-term structural support without adding significant superficial volume. Results appear gradually over months.

Combination approach: Sometimes combining deep filler for projection and biostimulation for skin quality provides the most natural, subtle lift without surgery.

Surgical options for more long-lasting or structural changes:

Fat grafting: Can restore midface volume and soften the under-eye area with your own tissue.

Mini midface lift: Targets midface laxity, elevates cheeks, and improves nasolabial folds while being less invasive than a full facelift.

Implants: Cheek or malar implants can add projection if your skeletal structure is naturally flatter.

Lower blepharoplasty: Considered only if there is persistent under-eye fullness, herniation, or sagging; not necessary if your main concern is midface volume rather than eyelid skin.

Summary:
Your concerns are primarily a combination of structural deficiency and early laxity, rather than just superficial volume loss. Non-surgical options like deep structural filler and biostimulation are excellent first steps and can give a subtle lift and improved support. Surgical options are more invasive but can provide long-term structural enhancement if desired.

Ultimately, a personalized approach, often combining filler with biostimulation, and reserving surgery for later if needed, tends to give the most natural, harmonious result while respecting your anatomy.

27, F – Midface volume loss or structural deficiency? Non-surgical vs surgical options? (Photos)

Answers (1)

More Cheek Augmentation Questions

How can I remove two lumps from my face? (Photos)

Mid face seems very flat - would you suggest cheek augmentation? (Photos)

What can I do to make my face more attractive? (Photos)

Do I have a negative orbital vector? What solution could make my eyes and cheek area more supported? (Photos)

Facial Flatness- Seeking Model-Like Facial Structure - how can I add structure and dimension? (Photos)

My face seems too narrow - would a wider zygomatic help? (Photos)

WE SEND PRETTY
EMAILS