Female, 32, with overly hollow cheeks and manly jaws - injectable filler or fractional laser, or what? (Photo)

In certain light, my cheeks and jaws look frankly awful. Gaunt and bony and even somewhat masculine. Injectable filler or fractional laser or what?P.S. I got an acid peel about 18 hours ago, so please ignore my leathery skin in the pics--it's temporary--and focus on where the shadows fall on my face. Please: help??

Doctor Answers 8

Cheek Reflation with Voluma

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Dear beastface:Looking at your photos, you could benefit from reflation of your cheeks with the dermal filler Voluma.  It will fill the hollow cheeks and give your cheeks fantastic projection and enhancement.  Softening of your masseter muscles on your jawline with Botox will help with feminizing the face.  Of course all of the above treatments, should be carried out by an expert injector.  Hope this information helps you and wishing you treatment success.

Hollow cheeks

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Dear Beastface,

Injectable filler (Juvederm, Voluma, Restylane, or Radiesse) or fat transfer would work well to augment your cheeks. Amount of fillers or fat needed will dependent on the patient's face. Speak to your surgeon about what is the best option for you. Laser resurfacing will help your skin texture (i.e acne scars), but will do nothing for your volume loss.
Good luck.

Kyle S. Choe, MD
Virginia Beach Facial Plastic Surgeon
4.6 out of 5 stars 42 reviews

Cheek volumisation and facial feminization

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Dear beastface,

It appears your midface has lost volume. Midface can be sunken from bone and soft tissue depletion, and that accounts for your sagginess. From your picture, you have lost volume in the anterior medial cheek, the submalar and parotid area.

Your options include hyaluronic acid filler, collagen stimulators and fat grafting. 

Hyaluronic acid fillers have the strongest evidence for safety and efficacy, with several level 1 evidence studies conducted. Of which, Voluma is FDA approved for the midface, with longevity of 18 months on average. 

Collagen stimulators, for example radiesse, sculptra take time to achieve peak results and possess mainly level 2 evidence to support its use. 

Fat grating is a surgical measure, but is operator dependent. 

For a straightforward treatment, I would suggest hyaluronic acid fillers. Filling up the abovementioned areas of volume deficit will help feminize your features and solve your gaunt and bony look.

Daniel Chang, MBBS
Singapore Physician

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Cosmetic treatment options for hollow cheeks and manly jaws

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Hollow cheeks are generally treated with injectable filler (Juvederm, Sculptra, Radiesse, Perlane, etc), fat injections, or cheek implants. Many choices available largely dependent on patient and plastic surgeon preferences, as there isn't one best option. "Manly jaws" are often due to large masseter muscles, which are usually reduced in size with Botox injections. Fractional laser doesn't help with the areas of your concern. These cosmetic treatments are performed in the office with topical or local anesthesia, except for some procedures such as cheek implants. If you haven't already, then speak with plastic surgeon to perform a comprehensive evaluation and review your options.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Nonsurgical Cheek Augmentation With Volumizing Fillers Works Well For Hollow Cheeks

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From the photos, it appears that the hollow cheeks are really emphasizing the jawline and that the former, not the latter is the main issue. Happily, nonsurgical cheek augmentation with the use of volumizing fillers has become quite routine these days among experienced injectors. My choice for this purpose in my Upper East Side Manhattan practice would be a combination of Radiesse and Voluma XC. Results are immediate and typically last up to two years. In my Israel satellite facility, where a far greater number of regulatory agency approved fillers and volumizers are available, I would opt for a combination of Emervel Volume and Teosyal Deep. 

I am not much of a fan of Sculptra, since it is not a filler, so it does not give an immediate improvement, requires a series of three treatment sessions, and is relatively expensive. I am also not a fan of fat injections. This, too, is typically a multistep process, requiring one procedure to withdraw the fat from the flanks, abdomen or buttocks, and the second procedure to inject it. And despite the claims that the results are permanent, one study evaluating fat transfer for mid-face volume augmentation (your area of interest) showed that less than a third of the initial volume injected remained after 1.5 years. 

Seek consultation with a board certified aesthetic core physician with experience and expertise in deep support volumetry, which is the fancy way of saying a three dimensional approach to facial volumizatio using volumizing fillers n to provide proper lift, projection and light reflection for the face. Make sure to ask to see before and after photos.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Facial volume loss

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This is a common complaint among young fit women.  Fortunately, there are multiple options for improvement.  The easiest treatment would be fillers such as Voluma or Sculptra (or both).  These can be injected in the clinic with little downtime. 

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews


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you have a slight negative vector in midface. and quite the hollowness in the cheek areas. someone like yourself will require a lot of filler to fill those in. Voluma is good option. if you were my patient I would consider and offer fat injections to create a foundation for your face then add Voluma if needed. in my experience that gives a better result and is rather cost effective for most patients.

Misbah Khan MD, FAAD, FACMS
New York Dermatologic Surgeon
4.9 out of 5 stars 32 reviews


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I think Voluma would be a beautiful option for you. It would highlight your cheekbones, round out the hollows in your lower face and lift the lower jaw line. Even better, it's an in office procedure with no downtime unless you have a little bruising.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 46 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.