Sculptra/fat transfer/Voluma/Bellafill, or Renuva for deep pyriform fossa? (Photo)

Thank you for your thoughtful and detailed question. Given your history of cheek implants and a SMAS facelift, it’s very understandable that the pyriform fossa hollowing stands out more now, and that you’re cautious about your next steps.

When addressing pyriform hollowness in patients with prior structural enhancements like implants, it’s important to maintain balance while minimizing the risk of migration or overcorrection.

Here’s a breakdown of the treatment options you mentioned:

Voluma: Another 1cc may help if placed conservatively and precisely, but I completely understand your concern about migration. While Voluma has a smooth consistency and integrates well, layering too much can lead to an unnatural look. If you proceed, it's best done incrementally.

Bellafill: Offers immediate volume and long-term collagen stimulation, which many patients appreciate. However, it is permanent and more difficult to reverse/manage if placed incorrectly. It can be used in the pyriform area, but only by someone very experienced in this specific anatomical region.

Renuva: A great option for natural-looking volume with gradual improvement over time. It essentially acts as a scaffold that your body repopulates with its own fat. Results can be subtle but effective, and it may be worth considering if you’re looking for a more regenerative approach.

Sculptra: Can be used for subtle collagen stimulation in the area, but requires patience and multiple sessions. It’s not ideal if you’re looking for immediate results, but it's lower risk for migration and quite natural-looking over time.

Fat transfer: This is a long-term solution, and can offer beautiful results when performed by an experienced surgeon. However, predictability can vary (especially in smaller, mobile areas like this), and not all transferred fat will survive.

My recommendation:
Consider a layered or combination approach tailored to your anatomy and prior procedures—possibly a conservative touch-up with Voluma or Bellafill with close monitoring, or exploring Renuva if you prefer a more regenerative option. Be sure to work with a provider who is deeply experienced in pyriform contouring post-implant.

If you’d like a virtual consultation to assess your facial structure and determine the safest next step, I’d be happy to assist.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. To address the pyriform hollowness you're experiencing, Sculptra may be an excellent option for you. Unlike traditional fillers, which provide immediate volume, Sculptra works gradually to stimulate your body’s own collagen production. This can help restore volume in the hollows of your cheeks over time, resulting in a more natural and lasting enhancement. Since you’re dealing with a structural issue rather than sagging skin, Sculptra can effectively add volume in a way that complements your existing cheek implants. The treatment involves a series of injections that promote collagen formation, which helps to fill in hollows and improve overall skin texture. Many patients begin to see results within a few weeks, with optimal effects typically occurring after a few months as the collagen builds up. One of the advantages of Sculptra is its longevity; the results can last up to two years or more, making it a worthwhile investment for long-term improvement. Additionally, since it stimulates your natural collagen, the outcome can appear very natural, blending seamlessly with your facial structure. I hope this helps and best of luck!

Based on the one posted photo, my recommendations would be Endo lift, laser, face cheek lift with one stitch, facelift combination under local anesthesia plus micro crafting to the area in question by side of nose under ultrasound guided injections, less than one cc per side. Fee $10,000. Best virtual consult with.