Male in 20's that has suddenly lost significant volume in my cheeks. What is the best course of action?

Hello there! Thanks for the photos and great questions. It's hard to say why you've had such significant changes other than genetics and aging, albeit early. The options you've described work well. Fillers last 8-12 months on average and provide nice volume correction. Migration can happen but not often if the correct product is used. The amount, also, can vary in order to achieve a desired outcome. Fat transfer lasts 5-10 years on average. Unevenness can happen. But often times, the amount of correction is so profound, that it is looked past if it occurs. There is no perfect solution and all require upkeep over time. I would seek consultation with a facial plastic surgeon to learn more. Hope this helps!

Hi and thank you for your question! Really great to see you becoming informed of all your options. You are right about all the complications possible with all three of those options. It is definitely best to have an in-person consultation to assess you and to go over what is most important to you in a treatment and an in-depth discussion of the possible complications. Having said that, I usually would steer patients like yourself towards hyaluronic acid (HA) fillers or Radiesse. HA fillers can migrate, yes, but you can get a temporary result to see how you like everything, and can be reversible if you don't like it. The risks are minimal and it very commonly done for the cheeks, so you can expect a great result. Radiesse is nice because although it may not last as long and cannot be reversed, it does help you build your own tissue and so a few Radiesse sessions may have a longer-term result with very minimal risk.
Best of luck,Dr. Brandon Elnekaveh

First, all your aesthetic issues are commonly encountered in any active cosmetic dermatology practice and, in experienced hands, are amenable to treatment with HA fillers, which have a proven track record for efficacy, reliability, durability, and reversibility if necessary. What's more the results are typically immediate and elicit a "Wow!" reaction. HA cheek augmentation can last up to two years. And what you call "long term reliance" is actually an advantage because as we continue to age there are inevitable continued losses of volume every few years in our fat pads, bone, muscle and cartilage, which can then be addressed directly with the HA fillers. On the other hand, Sculptra is relatively expensive, typically requires about three treatment sessions (no immediate results) and its effects don't really last much more than today's more robust HA fillers. Fat grafting is expensive, is a two step invasive process, doesn't last as long as promised, (since much of the fat removed from the donor site and separated from its blood supply doesn't survive) and that which does survive retains the characteristics of the region from which it was taken. SO, when it comes time for belly fat, for example, to develop midriff bulge that can happen now to the fat transplanted into the face from the belly. So, what would I suggest: a consultation with an experienced, board certified cosmetic dermatologist to discuss in detail which HA fillers would be best for your particular needs. Best of luck.