How could I plump the apples of cheeks in the long term naturally?

I don't have enough bony cheek definition to creat a fuller apple cheek, I have all round fat on my face with no definition, essentially a flat face with a depressed mid face and big nasolabial folds making me look old and saggy, those lines don't match up to create the full apple cheeks like Mariah C. I tried gaining weight to 'fill out ' but I ended up looking tired and constipated. How can Apple cheeks be achieved naturally? will PRP or paranasal augmentation help for nasolabial and cheeks?ty

Doctor Answers 3

How to permanently improve cheek definition, permanently and naturally.

Faces are flat as a result of a lack of sufficient forward projection of the bones of the mid cheek. There are 2 bones here, the outer bone is the zygoma and the inner cheek bone is the maxilla. It is the projection of the zygoma that is the cause of the problem. This bone doesn’t change with age, but the maxilla progressively shrinks and this shrinkage is first apparent in your twenties. This shrinkage is the reason why flat cheeks are not an issue in the teen years, but become so in the twenties and significantly more so in the thirties. The muscles of the cheek and the supporting ligaments of the cheek attach to the bone. If the cheeks do not project there is not good support provided by the cheek bones and this leads to the early development of  laxity of the ligaments that support the soft tissues. With laxity and poor bony support  the cheek soft tissues descend. This is what causes heaviness of the nasolabial folds.
The decision on how to treat this is straightforward. The underedeveloped bone, the zygoma needs to be permanently enlarged to a size that is normal and a shape that is attractive. Importantly, this is achieved using an implant that functions like bone. Soft tissue fillers and fat injections, while convenient, are just not sufficient for this structural function.
Paranasal implants add fullness to the inner cheek, maxilla. However correction of the maxilla alone is insufficient correction for this type of cheek flatness. The zygoma also must be corrected.
There are only 2 types of material to consider for this life long correction; prefabricated porex (polyethylene) implants or coral (hydroxyapatite) granules.
When you want natural, I would definitely use the coral. It is purified coral from the South Pacific and consists only of pure mineral, calcium triphosphate, the same as human bone. Significantly the surgeon shapes the granules to the desired shape to correct your individual situation. Then over time your own bone grows into the implant, so effectively, you end up with your own bone as the implant. This is the only natural implant. There is not reaction from the body or rejection.
In addition, because the cheek soft tissues have descended, they must be elevated with a cheek lift at the same time. It does not look correct placing an implant after the cheek tissues have dropped.
Mid cheek lift with hydroxyapatite augmentation is a most effective procedure and rarely needs to be repeated. People don’t detect that you have had a cheek augmentation. All they notice is that now you look healthy and well. Any suggestion of dullness on your face has gone and apple like cheeks remain.
You would need to look around to find an experienced plastic surgeon who performs this surgery as not many surgeons have significant experience with porex implants and fewer with coral.

Melbourne Plastic Surgeon
5.0 out of 5 stars 38 reviews

Filler or implants

If you are interested in natural products, you could have micro fat transfer.  This uses your own body fat as the filler to plump up the cheeks.  This will last forever.  This is the most natural option.  Alternatively, you could use fillers like Voluma, Radiesse, Sculptra, etc. These last about 2 years. Finally, you could opt for cheek implants. While these are not "natural", they do last forever and yield an excellent result.  Be well.

Sirius K. Yoo, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

Voluma in your mid-face

If you want to restore lost volume in the mid-face area I recommend learning more about Voluma. Voluma is a filler that can last two years and will instantly restore lost volume. Please consult with your doctor to determine if this is the best facial filler for you.

Bruce E. Katz, MD
New York Dermatologic Surgeon
3.8 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.