Will dermal fillers help address sunken cheeks and eyes?

Question

Hi, I have never had fillers before. I recently had a consultation with a plastic surgeon for fat grafting to the face. His opinion is that I don't have enough fat to harvest and address volume loss in temples, eyes and cheeks. What dermal fillers will help address the loss of volume in cheeks and around the eyes? Am I a good candidate for upper eyelid filler? Shall I start with 0.5 in all the areas?

Falguni Patel, MD, FACOG · Answer

While dermal fillers like HA-based products can help restore volume in the cheeks and temples, delicate areas like the eyes and eyelids often respond beautifully to PRP (platelet-rich plasma) or PDGF (platelet-derived growth factors). These treatments, especially when combined with microneedling, can stimulate natural collagen, improve skin quality, and gradually restore volume in a more regenerative, subtle way perfect for first-timers looking for a natural approach.

Anna Chacon, MD, FAAD · Answer

Thank you for your thoughtful question and for sharing your photos. Based on your facial structure and the concerns you've raised, you're indeed a good candidate for dermal fillers, especially since fat grafting isn't a viable option due to limited donor fat.

1. Cheek and Under-Eye Volume Loss:
To address the volume loss in your midface and tear trough area, hyaluronic acid (HA) fillers such as Restylane Contour, Voluma, or Belotero Balance are often preferred. These fillers are designed to integrate well into delicate tissue, providing natural-looking support and structure. Cheek volume restoration helps lift the midface and can improve the appearance of under-eye hollowness indirectly as well.

2. Upper Eyelid Filler:
Upper eyelid filler is highly specialized and must be performed conservatively due to the delicate anatomy of the area. You may be a candidate based on the hollowness visible in your supratarsal area. This is typically done using a soft filler like Restylane-L or Belotero, and only in expert hands. That said, lower eyelid and cheek correction often provides a much more noticeable improvement.

3. Starting with 0.5 mL per Area:
A conservative approach is appropriate for a first-time filler patient. Starting with 0.5 mL in each area (cheeks and tear troughs) is a good way to gauge your response and tolerance. We can always build upon the results with touch-ups.

4. Additional Notes:

Filler longevity varies by area but typically lasts 12–18 months in the cheeks and 6–12 months under the eyes.

Cannula technique is often preferred for tear troughs to reduce the risk of bruising and vascular compromise.

Please remember that facial balancing and harmony are key goals. You’re on the right path considering subtle and targeted treatment, and with the right filler choice and injector, results can be very natural and rejuvenating.

Nelson Lee Novick, MD · Answer

Let be start by stating the reasons I gave up performing autologous fat injections many years ago. For one thing, it is expensive. For another it requires large cannulas to extract the fat from the donor areas (usually buttocks, hips or belly), so it is a two step minimally invasive procedure that typically involves a fair amount of post-treatment downtime. For still another, despite the promises to the contrary, most of the fat transplanted to the recipient site does not survive being cut off from its original blood supply. And, finally, and perhaps most importantly, donor fat retains the characteristics of the area from which it is taken, which means that five, ten or fifteen years later, when the fat from the donor areas develops midriff bulge, the fat transplanted in the face can do so, as well--a pretty unhappy turn of events. 
On the other hand, there are a number of robust HA volumizing and lifting fillers that can be used to volumized the cheeks (which can not only improve the cheeks, but the under-eyes, as well), jawline, temples, etc. and that have immediate and reasonably long-lasting results, can be delivered by narrow cannulas or needles, and engenders little to no significant downtime. 
You would be wise to consult with a board certified cosmetic dermatologist filler expert and best of luck.

Jeffrey H. Spiegel, MD · Answer

Dermal filters are the perfect choice to restore volume under the eyes and the cheeks. Under the eyes we like hyaluronic acid fillers like Restylane or Vers. In the upper perimeter of the face and around the mouth is best to inject a combination of filters and combine hyluronic acid fillers with calcium based filler like Radiesse or Sculpra for biostimulation and elevation.

Camille Cash, MD · Answer

Yes fillers are a good option to help address volume loss in the areas that concern you.  Meet with an experienced injector for an evaluation.  The amount of filler used will be determined by your goals for treatment and the filler selected.

Leonard Grossman, MD · Answer

I would never put a filler in the lower eyelid hollows as it almost invariably leads to great problems. Some of the thinnest patients have enough fat either behind their hip bone or in the upper posterior arm area. I would most definitely recommend that you consider fat grafting. In the right hands, fat grafting will produce permanent and very natural results.

Will dermal fillers help address sunken cheeks and eyes?

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