What type of filler/collagen stimulator should I get and where is it to be applied? (Photos)

Question

I noticed some major volume loss in my midface and lips after my Invisalign treatment. Pictures are 7 months apart, (I’m 22 in both) & I weigh the same in each photo. My cheeks are no longer round & apple sized, instead they're flat and long. Almost like a deflated balloon. Because I lost a lot of volume there, my face is almost sagging, causing my eyelids to droop downwards. I also have deeper nasolabial folds now. How can I fix the volume loss and flatness? The only thing I’m scared of, is if I get cheek filler, will the sides of my cheekbone pop out more on the side? I’ve never had any sort of filler so I’m not sure what I need. I don’t want anything with a high risk of migration/ pillow face look. I originally wanted to do sculptra or ellanse but was told that isn’t good for a first time patient.

Anna Chacon, MD, FAAD · Answer

I can hear how unsettling this change has felt for you — especially at 22, when you’re not expecting to see flattening or early hollowing. When facial proportions shift, even subtly, it can change how expressive and balanced your features look in photos. I want to reassure you first: what you’re describing is fixable, and it can be approached conservatively and thoughtfully.

Orthodontic treatment like Invisalign can sometimes change facial soft-tissue support and muscle use patterns, and even small shifts in bite and posture can make midface volume look different in photos. Add lighting, angles, and facial tension — and the change can appear dramatic.

Let’s break this down clearly and safely.

✅ What you’re noticing anatomically

From your description, the main concerns are:

Midface volume loss / cheek flattening

Early deepening of nasolabial folds

Less support under the lower eyelid area

Lip volume reduction

Fear of looking overfilled or “puffy”

This pattern is usually best treated with structural midface support first, not lips first and not folds first.

✅ Best first choice for a first-time patient

For someone new to fillers, the safest and most controllable starting point is:

Hyaluronic acid (HA) filler
Examples include the Juvederm or Restylane family.

Why this is usually best first-line:

Reversible if needed

Adjustable

Predictable behavior

Lower long-term risk than stimulators when you’re still learning your aesthetic preferences

Can be placed very conservatively

Excellent for staged treatment

Your injector can build slowly rather than all at once — which is how we avoid the “pillow face” look.

⚠️ About Sculptra and Ellansé for first-timers

You were given reasonable guidance here.

Collagen stimulators like Sculptra or Ellansé:

Are not reversible

Build gradually

Harder to fine-tune in small facial areas

Better once facial structure and response patterns are well understood

They are excellent tools — but usually not my first choice for a 22-year-old first-time filler patient.

✅ Where filler would typically be placed first

This is the most important part.

Primary area: Midface support zone

Not the outer cheekbone edge — but the anterior and medial cheek support points.

This restores:

Soft cheek roundness

Under-eye support

Nasolabial fold softening

Overall facial balance

When done correctly, this does not make the side cheekbones stick out. That happens when filler is placed too laterally or too superficially.

Good midface work looks invisible — just refreshed.

Secondary areas (if needed after midface support)

Nasolabial folds:
Often soften naturally once cheek support is restored. Direct filling may be minimal or unnecessary.

Lips:
Small, conservative HA filler if true volume loss is present — not overfilled, just structural hydration and shape support.

Tear trough / lid-cheek junction:
Only if needed and only with very careful technique.

✅ How to avoid migration and “pillow face”

This comes down to:
Correct product choice
Deep structural placement first
Small amounts
Layered approach
Time between sessions
Avoiding overfilling lips and folds before cheeks

Overfilling usually happens from wrong sequence, not just wrong product.

✅ What realistic good work looks like

The goal is not sharper cheekbones or a different face.
The goal is restoring:
Soft midface contour
Gentle roundness
Under-eye support
Natural proportions

People shouldn’t notice filler — they should notice that you look like yourself again.

What type of filler/collagen stimulator should I get and where is it to be applied? (Photos)

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