Which treatment would help restore volume in my face? (photos)

Question

I am quite thin and I am losing face volume. There is a particular area on my face that I would like to have it plump … but I can’t find any information online. It seems that it’s not an area that could be injected? I am sending some photos

George Yang, MD · Answer

Hi, Belated Merry Christmas. It seems no one is answering this question. The normally full cheek under the cheekbone is called the buccal fat. If this area is sunken, then you have buccal hollowing. I prefer to “reinflate” this buccal area with a medium to firm Hyaluronic filler which can last 18-24 months plus. Depending on whether the patient is continuing to lose more facial fat (face is getting even thinner) then the result may appear to last less than the 18-24 months. I have had patients who had filler back in 2015 and during the pandemic they gained 5-10 pounds and felt to full in the buccal fat area and I dissolved some of the filler from 5 years prior and it still reduced in fullness. Based on these experiences, my impression is that the filler was there the whole time, but the appearance may vary. If I inject 1.0-1.5 cc into this buccal area to reduce the sunken area as well as provide some plumpness if you were to push on the sunken area of the cheek, to provide some “bounciness” like when we were younger. 
Since many people are currently in weight loss medications like Ozempic or Wegovy, they may lose even more facial fat ( perhaps another 1.0-1.5 cc per side). This doesn’t mean the filler is gone, but instead more fat was lost. Interestingly, if these patients stop these medications, they may get a rebound weight gain may replenish the cheek fat as in the case of the Covid Weight gain patients and no longer want the filler anymore. Luckily there is an antidote which can dissolve partially or more fully the filler implant. If the patient had fat grafting the 1.5 cc of fat will grow to more than 1.5 cc when they gain weight on top of the facial fat growth, but also shrink when they lose weight in addition to the facial fat shrinkage. The hyaluronic acid implant stays the same size regardless of the patients weight gain or loss and is reversible as well as have the ability to add more into the sunken area to add to the existing hyaluronic acid implant to make it larger if desired. 
I tried to include an Instagram post from 2018 if it will work. This patient has not had a refill in her buccal area since her original filling before 2015. 
Last point is that I would not place any filler on your cheekbones which would further pop out the cheek bones which would make your face even more bony and skeletal. Most injectors seem to recommend injecting cheekbones when the patient’s face loses cheek volume. This never made any sense to me. 
The goal is to soften the face and create fuller cheeks from the cheekbones down to the jawline. The firmer cheeks we are trying to achieve is where an aunty or grandparent would pinch a child’s firm cheeks below the cheekbones. The grandparent is not pinching the bony part of the child cheekbones. 
Hope this helps to answer your question. 
Best, Dr. Yang

Hilton Becker, MD · Answer

Fat grafting is a good option for volume restoration.
It does however require. More than one treatment

Which treatment would help restore volume in my face? (photos)

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