28/F, Juvederm Voluma vs Sculptra for sunken cheeks? Best tear trough filler? Feeling desperate. (photos)

There is absolutely no substitute, including HD photos, for an in-person examination (that allows palpation and manipulation of the skin) when evaluating the face for the best nonsurgical volumizing approaches for shaping and contouring the face. From what I can determine from the photos, there appears to be significant volume loss in the posterior cheek region (near the posterior angle of the mandible), rather than in the upper cheek area. There also seems to be a significant degree of chin recession, at least in the view provided, and some hollowing under the eyes. Radiesse, a calcium-based volumizing filler, would do the job for the posterior cheek and would last at least 1.5 years, but, since there is no enzyme to dissolve it, leaves a problem if for any reason the result is not optimal or if there is any complication. The same may be said of fat injections, which tend also to be expensive and necessitate an invasive two-step procedure (one to harvest the fat from the buttocks, belly or hips, and the other to inject the bulky fat particles through large bore cannulas). Moreover, despite the promise of permanence, most of the fat injected typically lasts about the same 1.5-2 year period. Even more potentially troubling, any fat that does remain retains the characteristics of location from which it was taken--meaning that if belly fat increases with age, so may the residual fat transplanted in the face. Sculptra, a relatively expensive collagen and elastin fiber promoter is product that may last up to two years, does not yield immediate results, and typically requires at least three treatment sessions before any significant benefits can be realized. Voluma XC, on the other hand, a hyaluronic acid-based injectable, may last up to two years in the cheeks, also possesses ability to stimulate new, native collagen and elastic fiber synthesis, and may be dissolved if necessary with the enzyme hyaluronidase. For under the eyes, I do not use ordinary Restylane, as this may result in lumpiness or small bumps or plain Juvederm, as this product possesses a great affinity for attracting water molecules, which can translate into swelling under the eyes. Instead, I typically use Belotero Balance, which goes in smoothly and evenly and possesses little to no tendency to give rise to the unwanted bluish/gray Tyndall Effect when injected superficially into the delicate tissues of that region. Make sure that you consult with a board certified aesthetic physician and ask to see his/her personal before and after photos for each area that requires treatment. Best of luck.

Facial sculpting and contouring of the face can be created with well-placed fillers (Voluma, 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

Under eye hollows and cheeks can be permanently corrected with surgery or temporarily camouflaged and augmented with fillers which can also help nasolabial folds.There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye. 
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

Thanks for sharing your concerns.  Based upon your submitted photos, there are few things I would recommend for best results.  I would recommend Restylane Refyne for underneath the eyes since it potentially has a longer duration than regular Restylane.  I do see some fat wasting below the cheeks which is causing more of a gaunt look and this is best treated with Sculptra.  Even though it will take 6 months to take effect, I think it looks the most natural and has the longest duration 18-24 months in this area.  Ultimately, which ever product you end up choosing, your results are determined by the injector so I highly recommend that you go to experienced cosmetic surgeon who will know how to combine different injectables/modalities.

Juvederm or Restylane both can address the hollowness of the tear troughs. For the cheek area you need to decide which is more important to you. Sculptra will give you a longer lasting result but you are correct in that it takes longer to see results. Voluma does a great job and some result is seen right away, but it is temporary. Voluma can last up to two years. I've included a video I hope you find helpful.

I would recommend going on a few different consultations with multiple skilled providers. I like Sculptra for the lateral cheeks and overall facial volume loss such as yours. 

You have a lot of options to volumize your face . I would consider Voluma for your cheeks which is supposed to last two years , and for your test trough area Boletero would work fine. For your lower face Juvaderm or Radiesse would work. Sculptra is good if you want long term changes.

I decided years ago that other fillers were superior to Sculptra. For many years I used Radiesse. It lasted an average of about 18 months and gave immediate results. Although it needed to be reinjected,  I never had to use as much the second time to achieve the same results as I did the first time. I have since switched to Voluma that lasts significantly longer. I have never had it last less than 2 years when used for volume filling. Some of it also seems to be used by the body to build its own collagen, much like Sculptra is supposed to do. There is also now data proving this latter point. Since I switched to Voluma, I am even more convinced that there is no place in the injection market for Sculptra, as Voluma is quite long lasting, corrects exceptionally well, is partially used for collagen production and the results are immediate.