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

Question

Over the past year I have noticed sudden and alarming changes in my face. Significant degradation of my inner fat pads, leading to flat cheeks, deep nasolabial folds, and droopy mid-face. Best course of action? The solutions are very scary. Dermal Fillers = unpredictable migration and long-term reliance. Skulptra = nodules, permanent mutilation. Far too many horror stories! Fat Grafting = probably the best solution, but unpredictable and potential for uneven fat. What do you suggest?

Nelson Lee Novick, MD · Answer

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.

Viktoryia Kazlouskaya, MD · Answer

All of the options you mentioned definitely can be done and are pretty safe in the trained hands. You will benefit most from a combination approach - skincare, re-surfacing, biostimulation with Sculptra (which can be used in higher dilution to prevent nodule formation), and fillers for volume loss. Dr. K

David M. Kowalczyk, MD, MBA, FACS · Answer

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!

Robert L. Kraft, MD, FACS · Answer

It isn’t uncommon for loss of puppy fat to occur in mid20s even if your weight remains constant.  Fat grafting is subject to unequal take, is not permanent and you must have adequate quantity of fat. I personally would recommend Radiesse-the migration concern is misplaced and it isn’t a long term commitment.  Restylane could also be an option. In any case, consultations are best had in person. Best wishes.

Leonard Grossman, MD · Answer

The photographs you have submitted look, absolutely normal, but you should know better, because you have pictures of younger days to compare to. The most common causes of fat loss in the face besides illness, include use of anabolic steroids, as well as testosterone.
If, indeed, you have no reasons to explain why you have lost this fat, I would recommend using your own fat because the results are predictable and practically permanent when performed by someone with a lot of experience in fat grafting. I hope this helps and good luck from New York City Plastic Surgery.

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