When comparing a cheek implant and fat transfer to Voluma, how many syringes would you need to get comparable results?

Thank you for your question. You’re about volume to create the effect you would get with a cheek implant with an injectable filler versus fat transfer. You’re asking if there are more permanent solutions for cheek volume, why wouldn't someone choose a more permanent solution such as a cheek implant or fat grafting as opposed to filler as you describe every 2 years? And also, does technique matter?
I can discuss this for hours, but I’ll give you an overview on how I counsel my patients who ask the same question almost every day in our practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I perform all those procedures you describe, from cheek implants, fat grafting, and injectable fillers. I can share with you my own evolution in determining recommendations I make to my patients every day in my practice.
It’s very important to first understand that the concept of permanence is fleeting because our faces continue to change. In terms of an evolution, before we had such a good variety of injectable fillers, my natural inclinations particularly as a surgeon was to recommend the placement of cheek implants, then into early to mid 2000s also offer fat grafting, then when longer lasting fillers came along, I evolved. Permanence is not truly a long-term solution because when you think about a, “permanent solution”, you can look at people who had silicone injections 20 years ago, and how they look now; you can look at fat grafting 10-15 years ago, then now.
You can appreciate that facial aging is a progression of volumetric loss, most significantly at the bone level, and its impact on the facial structure. Cheek implants are a very good strategy for volume correction. However, when you think about the options of a cheek implant versus a fat transfer, or versus filler, it also has to do with relative indication based on skin thickness, and the type of individual we are treating.
For the solutions that patients ask me for, I gravitate to, and see a very high success rate with something called Structural Volumizing. The point of this statement also has to do with the lifestyles of our patients. When I was in training back in the 90s, my preceptors were among the top cosmetic surgeons in the country, with a large percentage of patients with significant affluence who would undergo a lot of procedures, then hide for weeks and weeks. The modern patient often, even if they are affluent or not, are very busy with a lot of responsibilities, and cannot hide for weeks. In terms of lifestyle and predictability, there is a high premium in getting the optimal procedure, with minimal risk and maximal predictability, and almost no tolerance for complications.
When you think of the equation in that respect, we also have to think of the level in which fillers are placed. Often, people who go for fat grafting are very disheartened by the lack of predictability. In spite of significant improvement in the processing of fat after harvesting, there’s still a significant unpredictability to fat grafting in my experience and opinion. Between fat grafting and fillers, fat grafting and fillers are typically placed just below the skin in the soft tissue of the cheek. What that unfortunately can result in is a rounding and an overfilled, exaggerated, and unnatural look. This is where Structural Volumizing comes into play. If we use the same principle for cheek implants directly on the bone structure, but place filler with a certain thickness between the bone and the muscle, you can get a effect that’s comparable to a facial implant, but avoiding surgery and the potential issues of facial implants. Essentially you get the most predictable outcome with the lowest risk. Further, a lot more people are willing to undergo fillers than are willing to undergo cheek implants.
In my practice, currently we do a lot of Structural Volumizing. To be more clear, I’m using a special instrument to place a thicker filler such as Juvederm Ultra Plus or Juvederm Voluma at the bone structure level. I can enhance the cheeks, jaw angle, chin, jawline,  and I can do all this in a matter of minutes, with someone having the results and look like they’ve had a facelift, without undergoing surgery. That’s a significant advancement in helping people look their best, with the lowest risk, and least amount of time.
In the closing of your question, you asked if technique matters. I would say absolutely, technique definitely matters. It’s important you learn this in terms of your strategy, and depending on what is right for you. If you’re more amenable to cheek implants, it’s a very viable option. I would probably discourage you from fat grafting because of the challenges with predictability, asymmetries, and irregularities, but that’s my opinion. For most of my patients with a similar concern, we pretty much end up going to Structural Volumizing and getting the results that in so many ways are so convenient to a patient’s lifestyle, so it’s hard to choose something else.
Learn more about these options including the concept of Structural Volumizing which will I think will enhance the depth of your understanding of injectable fillers, and why very rational, smart people choose something like Structural Volumizing instead of a more permanent solution. I hope that was helpful, I wish you the best of luck, and thank you for your question.

This is an excellent question. Bear in mind that fat will eventually at least partially absorb, sometimes unevenly ! Fillers such as Voluma (or Radiesse) also will be temporary. Implants are very predictable, permanent (though reversible) come in many sizes and shapes pending your specific esthetic needs and desires.The volume of filler used (hence the cost) depends entirely on the size of enhancement you need or want. Seek an in-person consult with an experienced cheek implant PS. The best !