Flat cheeks and prominent deep nasolabial folds. Am I a candidate for a mid-face lift or fat transfer? (photos)

You have a variety of options, from permanent implants to fillers that last a few months to about a year (your case Voluma would be perfect!), to facial fat transfer. Yes fat transfer is unpredictable, but works quite well and produces very nice results. Fat is taken, usually from around your lower abdomen area, using a small cannula through your bellybutton, then cleaned and reinjected into your face. Its a wonderful procedure with wonderful results and will suit your needs well. Good Luck!

The midface is always the most difficult area of the face to work, and one thing to remember is that no procedure exists that will give a permanent result - you always continue to age. Having said that, you can certainly make a nice improvement by increasing the volume of your flattened areas. Fat would be the best thing to start with because more can be injected at one time, giving you a better result as compared to one cc of Juvederm.

Fillers and fat may be reasonable options for your concerns.  It will take a significant volume to address these concerns. Consider scheduling another consultation.

First of all, you're too young for facelift of any kind. The nasolabial fold is generated by facial expression and will reemerge after a facelift. Fillers are the best solution.

I wouldn't consider a surgical lift for you, but augmenting your cheek volume may get you the look you want.  Fat grafting would be an option, however it's unpredictable how much of the fat will get reabsorbed by your body.  Although you've tried Juvederm Ultra, a newer type of filler called Voluma is available and provides much more robust augmentation.  It's specifically designed for the cheeks and I've been able to achieve nice results with it.Best of luck,Keith Blechman, MD     

Based on the photos, replacing volume to your midface is your best option.  That can be with your own fat or with something like Voluma.  Whatever you choose, it won't be permanent no matter what anyone tells you.  It will not stop time.  And, unfortunately your will face will change as you age.  However, if done right and not overfilled, it will definitely make you look better.   I don't recommend a surgical facelift at this time.

You can try a bit more filler than one syringe in the midface because of the midface flattening.  Best of luck with your decision to move forward.

You have a very flat midface, particularly in the paranasal- maxillary region. This makes you vey susceptible to deep nasolabial fold areas up close to the nose. The reason injectable fillers did not work is that the volume used was way inadequate. The best long-term treatment would be extended paranasal-premaxillary implants which would push out the bony area around the base of the nose. (central maxillary region) The more superficial folds could also be treated by fat injections at the same time.

At 22, I would not recommend any surgery for you.  One syringe of Juvederm may not have been an adequate dose and I would not dismiss fillers offhand based on that experience. Fat transfer is not a permanent solution and has its own risks/consequences.  Nothing in cosmetic procedures can be considered permanent as the facial changes that come with aging will continue nevertheless.

Fat injections in the cheek are too inconsistent and can be temporary. In our practice when patient's want to perform an augmentation to the mid face area, we insert Silastic cheek implants. Cheek implants are manufactured in a variety of sizes and shapes, are inserted through an intra-oral approach under a brief general anesthetic as an outpatient surgical procedure. Cheek implants offer a permanent and predictable augmentation of the cheeks.  For many examples, please see the link and video below