How can I achieve cheek lift/mid face volume at the apples of cheeks without the cheekbones sticking out from the side? (Photo)

Question

I was looking at multiple mid face volume fillers and their results. I was also looking at non surgical ways to give the mid cheek a lift which helps with the tear trough area BUT many pictures show this ridiculous look that looks fake. The cheekbones stick out and have this "glow" that is not attractive like in the pictures below. I want to add volume to my mid face to "lift" and help with the tear trough area as well. How can I achieve my goals while avoiding these absurd looks in the photos?

Jason Emer, MD · Answer

Facial sculpting and contouring can be created with well-placed fillers (Voluma, Countour, Radiesse, Bellafill) and Sculptra, which would give improvement in facial balance. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Jed H. Horowitz, MD, FACS · Answer

Hello engrilCheek implants are used to increase the projection of the cheekbones. They increase the fullness of areas of the cheek that may be receded or flat. Cheek implants add body and contour to cheeks that lack definition. Fillers such as Juvederm Voluma, Radiesse and RestylaneLyft are great alternatives to cheek implants, also fat transfer or injection can be done.

Chad K. Wheeler, MD · Answer

Using facial fillers to improve your mid face volume makes sense.  We loose fat and bone in the face as we get older.  Everything in plastic surgery can be over done so the pictures you show are examples of too much.  it is easy to improve someone without over doing it.

Francis R. Palmer, III, MD (retired) · Answer

Hi, not only can you have that shape creating in your cheeks...that "is" the proper aesthetic goal for cheek shaping.   The "apple cheek" which I define as being full and round "in the front", not at the sides of the cheeks (which actually broadens and masculinizes the cheeks and face) will create youthful, feminine appearing cheeks.
 I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts that incorporated the proper aesthetic shaping of the "key" facial features.  Non smiling photos, of your face, from the front and side would help in the evaluation.  
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  If the cheeks are flat or concave in the from, cheek augmentation with proper and precise placement of a dermal filler or using silastic cheek implants (for a permanent enhancement) can create full, round cheeks that will feminize the entire face.  Placement of a dermal filler or a cheek implant to the outsides of the cheek widens the face making it appear more square shaped and masculine.  While this has become increasingly more commonplace (supposedly to lift adjacent soft tissues), I completely disagree with the aesthetics of augmenting the cheeks in this manner and what it ultimately does to the shape of the face.  It's simply an "urban myth" that placing a dermal filler to the outsides of the cheek will lift nasolabial folds of the face.  The amount of filler needed to overfill the outside and front of the cheeks results in the telltale overfilled chipmunk cheek.  This does not create a soft, feminine and naturally beautiful cheek or face.  I have been called upon many times to dissolve or remove the injected material in cheeks that have been over filled (on the outsides and front) with dermal filers or fat.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
 Some final words regarding fat injection or fat transfer.  I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

Theodore Staahl, MD - Account Suspended · Answer

Fillers are a great option for providing cheek volume to help lift the face.  As with anything, it can be overdone.  I recommend having a few consultations with board certified facial plastic surgeons so that you can find a provider who best meets your needs and goals.  I would also recommend viewing before and after photos, as well as letting them know you're looking for a natural look.  
You can always add more filler so try going slowly.  Have some filler injected, wait a few weeks or even months, and then add more as you like.  It's better to have to go back for more than it is to feel like you want to have some taken out.

How can I achieve cheek lift/mid face volume at the apples of cheeks without the cheekbones sticking out from the side? (Photo)

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