Negative orbital vector with under eye hollow and very little cheek volume. Which is better, fat injection or implant? (photo)

Question

I would like to correct the negative orbital vector and to build up my cheek volume. Would fat injections or an implant be better for this? I would prefer the fat injections; however, I am worried that the fat injections would not retain and may be lumpy since my tissue is thin in this area.

Nelson Lee Novick, MD · Answer

From the photos, it appears that there is a significant absence of volume in the region of the mid face (i.e. below the under eye (infraorbital) region, which is contributing significantly to the elongation of the lower lids and the hollowing in that area. The use of injectable volumizing fillers can quickly and easily remedy the problem. In my Upper East Side Manhattan office, I would opt for Voluma XC for this purpose and in my Israel satellite facility, where a far greater number of regulatory agency approved volumizing fillers are available, I would opt for Stylage XXL or Restylane Volyme (formerly called Emervel Volume). In this facial location, results typically may last up to two years. The support provided to the under eye region by treatment would very likely, secondarily improve the  hollowing to the extent that the infraorbital region might not even require any additional, direct treatment, or if it did, would require much less. I am not a fan of autologous fat injections, and gave up performing them many years ago, since the process tends to be expensive, requires TWO separate procedures (one to withdraw fat from the abdomen, buttocks and a second procedure for re-injecting the processed fat via a large bore cannula into the desired region). There is also the issue of lack of easy reversibility should there be lumps or other unwanted outcomes.  And while the result of fat injections are oft touted as "permanent," a recent, January 2017 article in the highly respected trade journal, Journal of Drugs in Dermatology,  the longevity of autologous fat injections was listed at only 6-24 months, a number that in my opinion hardly justifies the negatives mentioned above. You would do well to seek consultation and treatment by a board certified aesthetic physician with experience and expertise in treating the male face. This is not a region or situation that should be left to the hands of a novice injector accsutomed only to treating simple smile lines with ordinary Restylane or Juvederm. Inappropriate volume placed in the central portion of the face can feminize a male face. Make sure to ask to see his/her before and after photos before agreeing to proceed. Best of luck.

Jason Emer, MD · Answer

You can have a successful result with fat to this area. A gentle technique is important for successful transfer and good results. I use gentle water-assisted harvesting to get the most viable fat to transfer. I then combine with prp to maintain and improve final results. Fillers are an alternative, which can be used for tear troughs and cheek volume, and allow you to try on the look before committing to a more permanent solution. See an expert for a formal evaluation. Best, Dr. Emer

Mehryar (Ray) Taban, MD, FACS · Answer

Lower orbital rim or extended tear trough implant is a better solid foundation support to correct negative vector and hollowness. See an experienced oculoplastic surgeon.

William Portuese, MD · Answer

Cheek implants offer a predictable and consistent result when augmenting the mid-face. Fat injections are very unpredictable as to how much fat will live after the injections. Cheek implants are manufactured in a large variety of sizes and shapes, are usually placed through intraoral approach under brief general anesthesia as an outpatient procedure. For more information and many before-and-after examples, please see the link and the video below

Sean Freeman, MD · Answer

mcwa227, Although I perform fat injections I do them sparingly. I know some of my colleagues feel otherwise and that is good for discussion purposes but in the majority of my patients I can achieve improvement in hollowness under the eyes and cheek area using other more predictable methods. One of the drawbacks of fat injections is that one has to over-fill to begin with to account for expected absorption of some of the transplanted fat. That in and of itself is the reason I use this approach sparingly as the percentage that injected fat gets absorbed is different for each patient. I’ve seen patients with little absorption who look over injected for a prolonged period of time; I’ve seen patients who absorb the transplanted fat fairly aggressively (they look fairly good for about a year but after that you can barely tell you did any injections) and I’ve seen patients that get a good result that can last several years. I don’t like doing things that have that much variability. As the originator of the SOOF lift blepharoplasty I can tell you that in my opinion this is the best procedure for improving the hollow look under the eyes that accompanies the aging process. I've been doing nothing but this procedure since I originally published this approach around 1999 in the Archives of Facial Plastic Surgery and have only had one redo to date. For cheek’s I prefer a midface lift should they have adequate midface fat left and if not I prefer a cheek implant. All these techniques work predictably and last many years with little known risks. Always see a surgical specialist that does "onlyfaces" and has decades of experience. See the video and good luck!

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years. Following my beauty principles, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.  From the photos, your cheeks are very flat (concave) 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.  In my opinion, you are a good candidate for chin implant surgery.
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.
 Im my experience, despite its recent gain in popularity fat transfer (fat injections) offer far less of a reliable and predictable volume for shaping the cheeks than an off the shelf dermal filler of silastic facial implant (cheek implant, chin implant, lip implant).  For this reason, I do not use fat to shape the cheeks, chin, lip or jaw line.  In my opinion, for those that are suitable candidates for silastic cheek implants as you appear to be, silastic cheek implants remain the "gold standard" method of cheek augmentation.Hope this helps.

Marc J. Salzman, MD, FACS (retired) · Answer

Thank you for your question. From the look of your photograph, I see both malar and submalar hypoplasia. While a cheek implant will correct the malar hypoplasia,  it will not correct the sub-malar portion. My concern for fat grafts would be not only the overlying thin soft tissue but also the availability of enough fat to do the job. In my experience, the adding of PRP has worked beautifully in stabiilzing fat grafts so they do not become lumpy. Hope that's helpful.

Negative orbital vector with under eye hollow and very little cheek volume. Which is better, fat injection or implant? (photo)

Answers (7)

More Cheek Augmentation Questions

Ways to improve nasojugal groove/tear trough in addition to nasolabial fold? (photo)

Help! How do I get chiseled high cheeks without looking puffy, and slim down my square jaw/lower face? (Photo)

Options to achieve sunken cheeks and high cheekbones?

Is my overbite contributing to my weak chin and double chin? Would getting invisalign give me a more defined chin/jaw? (Photos)

Sagging cheeks like a bulldog - what can I do? (photos)

I always noticed that my left cheeks and cheekbones are not equal to my right, how can I fix it? (photo)

WE SEND PRETTY
EMAILS