Which procedure is suggested to lift sagging cheeks, under eye bags and nasolabial folds? (Photo)

Thank you for your question. You submitted a photo with your eyes blocked out, describing a situation where you’ve had sagging cheeks for your entire life, and your nasolabial folds are worsening as you get older, even if you are still young at 28-years-old. You also state you have under eye bags, which we can’t see in your blocked out image. You ask if there is some way to lift the area of the cheeks to improve the overall appearance. You also mention some acne scarring.
I can certainly help you understand what is probably contributing to this perception. 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 I perform a full range of procedures including minimally invasive, to advanced surgical procedures, so I can give you an understanding of how I would interpret what you describe.
At 28, you are still very young, so what you have dealt with throughout your life is more about anatomy and not about age-related changes. You can have the perception your cheeks are sagging, but I believe what is equally relevant and probably more appropriate for you is your cheek is not well-defined. There is a difference how we treat people with facial aging, which is about restoring volume loss and sagging. With younger people, it is more about subtle but natural-looking enhancement to beautify and create balance. I would suggest for someone like yourself to do the least amount possible to try to get the best outcome.
For the cheek and nasolabial folds aspects, it is worth considering a procedure we call structural volumizing. Structural volumizing is the application of traditional fillers such as Juvederm Ultra Plus and Juvederm Voluma, but in placement different than traditional filler application. Traditional fillers are typically placed in the cheeks, and right under the skin whether it is in the nasolabial folds or the cheeks. In structural volumizing, we are placing it between the bone and muscle. We do this keeping the Golden Ratio of facial harmony facial balance in mind, which is a width of 1.6 to 1, so the upper part of the face is slightly wider than the lower part. Interestingly, it can make a person look thinner. The Golden Ratio is a concept that has been around since ancient times. With structural volumizing in the cheekbone area, accentuating the cheekbones can actually really enhance the overall appearance of the face. What I like about considering a hyaluronic acid filler like those I mentioned is in a worst case scenario, you can dissolve these fillers and start from scratch. The reversibility of this approach makes it very appealing.
If you have had under eye bags for most of your life, then there is a very good chance you are dealing with lower eyelid fat prolapse, which means that the fat pockets normally around the eyes pushed forward and created a bulge. I’m not getting ahead of ourselves and saying you are a good candidate for one procedure or another, but the options for under eye bags in my practice are based on the relative prominence of the under eye bags. If they are subtle, they can be blended with an injectable filler like Restylane to fill the area of the tear trough to create a better transition between the under eye bags and the adjacent area. We also use platelet-rich plasma (PRP) derived from your own blood, but that is a different story if you don’t have much wrinkling or discoloration under the eyes. If the under eye bag is more prominent, it is not amenable or appropriate to treat this area with fillers because you might create too much volume. In such cases the option is a procedure called lower eyelid blepharoplasty, specifically a transconjunctival blepharoplasty.
I recommend you take little steps. You are still very young, so my personal style is to tend to be very conservative. I always tell younger people that once you get into your 40s and over, there will be plenty of opportunities to do things because facial aging changes will manifest more significantly. Prior to that, little things can go a long way, whether it is cheek augmentation or lip augmentation. Little things can make a nice difference for people who genetically do not have volume on those areas they desire to address.
Learn about these options, and find a doctor you are comfortable with. You really need to feel comfortable with the doctor’s style, their aesthetic, learn about what you like, and what you want to try. Very often, when we discuss these issues with patients, we come up with a priority list, figure out what’s the highest priority, and go with what has the most significant impact, cost the least, and will likely be satisfactory. You may need to visit a few different doctors to find what you are comfortable with, then move forward to take your first step.I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Hello caligirlCheek implants are available in a range of different shapes and sizes, they are mostly customized to fit a specific facial structure. Fillers such as Juvederm Voluma, Radiesse and RestylaneLyft are great alternatives to cheek implants, also fat transfer or injection can be done.