Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years. The photo shows cheek fullness from excess fat over the cheeks (when smiling). Liposuction remains the "gold stand" for reducing unwanted fat. A resting, non smiling photo from the front and side would help in the evaluation of the cheeks and mid face. This would determine if the cheek bone volume is adequate or is flat or even concave in the front. Flat or concave cheeks lack adequate cheek bone volume to support the overlying cheek tissues. This allows the tissues to sag towards the nose and mouth creating nasolabial folds, jowls and marionette lines. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front. Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face. There are many faces that have excess fat over the cheek area which hides the "true" shape of the cheeks below. In addition to obstructing the cheek shape, this excess fat will sag prematurely as it is pulled by gravity at an accelerated rate versus a face without excess fat in the mid face. Removal of the excess fat, with liposuction, is key when properly shaping the cheeks with cheek implants. I have used this in combination with cheek implant surgery for 30 years. In my experience these procedures when combined in a face with excess fat in the mid face are extremely safe, effective and reliable in the aesthetic results they produce. Hope this helps.