What can be done to weak cheeks? (25 year old female). (Photos)

Question

I’m wondering what can be done about my sad cheek situation. Not doing Voluma (fillers only last 3 weeks for me) and I’m not doing fat transfer AGAIN (had a failed fat transfer to cheeks and lips) So what permanent fix can I do? Mid face lift? Buccal fat removal? Cheek implants? The doctor that did the fat transfer thought I had major weight loss due to my sunken cheeks. I haven’t. It’s just genetics. I just think my whole face would look so much nicer if I had cheekbones and no jowls.

Jonathan Kulbersh, MD · Answer

Both implants and fillers in the cheeks can create good results for patients.  Both can build up the cheeks and create symmetry.  You must balance the pros and cons of each procedure and do what you feel is the best decision for you.
Fillers:
Pros: No downtime Reversible Quick
Cons: Temporary More expensive in long run
Implants Pros: Permanent Great for patients with poor bone structure Less expensive overtime
Negative: Risks associated with surgery Possible infection DowntimeHope this helps.

Sean T. Lille, MD · Answer

Thank you for providing your photographs. The first thing to do is to go to a qualified plastic surgeon who is familiar with all the non-surgical and surgical options available to you. There are several non-operative options that include Different types of facial fillers.  Some are specific to certain areas of the face and used for only deeper layers like Voluma.  Others can be used more superficially in the subcutaneous tissue.  Operative techniques include using cheek implants or fat grafting. I have done both and I prefer using your own tissue with fat to augment the cheeks.  You don't need very much and it's important not to create disharmony in your face. All the best!

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question and pictures.  Firstly, you have a lovely face, you definitely do not have jowls so a facelift wouldn't be suitable.  I think if you try tried dermal filler and fat transfer then cheek implants.  Please make sure you find a reputable and qualified plastic surgeon

John Michael Thomassen, MD · Answer

You are too young for a facelift.  Usually fillers are the best option in your age group and the most natural filler is fat.  Other HA fillers will not look natural after several injections.  You may not have had a good results from the fat grafting the first time but a second attempt may take.  Placing micro fat grafts along your lower orbital rim and malar eminence would be indicated.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you are a great candidate for malar enhancement.  This can be
done in one of two ways.  Voluma is an injectable filler which can be
injected into the malar region as a temporary filler.  Malar implants can
be placed as a permanent way to gain volume in the cheek.  I always use
medpor implants with screw fixation.  Silicone malar implants tend to
have a high rate of malrotation over time.  The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

P. Daniel Ward, MD · Answer

Thank you for your question. I think that you are right in that adding volume for the cheeks is the right idea. This can be accomplished through fillers or through implants. Since you do not want to use fillers, implants are the next best option. Implants can be placed under local anesthesia or with sedation and are a great way to add volume to the face.Please let us know if you have any other questions or concerns.

Graeme J. Southwick, MBBS, FRACS · Answer

I appreciate your question and the many photos you have included with your inquiry. A facelift of any kind would not be appropriate for you based on your age and the fact that you don’t have skin laxity or wrinkles to address. There are three options for targeting the cheekbones and two of them you have tried – dermal fillers and fat transfer. However, I would encourage you to take another look at those choices with another specialist plastic surgeon and possibly a different filler formation. If the nonsurgical options do not appeal to you at this point, cheek implants would be your next step. These synthetic implants come in an array of sizes and shapes to accommodate every facial profile and the surgery involves no visible incisions and minimal downtime. Good luck!

Chia Chi Kao, MD · Answer

Based on your photos , you have shallow malar bones and unwanted fullness in your lower face/Jowl areas. What you prefer is a higher cheek mound and more tapered lower face. Just adding volume in your cheeks, either with fillers, implants or fat only solve half of the problem, it does not create a concovity in the Lower third of the face (heart shaped face). 
When you put your fingers on the temples and pull up, that rotate the tail of the brow, lifts the cheeks, and the jowls. Your face now looks more heart shaped, tapered, and more beautiful. This is exactly the desired effect of the Ponytail Lift. There are two tiny (1cm) Endoscopic access incisions in the temporal scalp that are totally hidden and maybe a another small access incision behind the ear totally hidden in the crease. This is not a facelift. A silicone cheek implant can be inserted through the same temple incision without the risk of infection or malpositon going through the mouth. The subperiosteal pocket is created endoscopically just the same size and shape of the implant so it fits  like a glove. There are no chance ignore implant rotation or malrotation. 
We have now 18 years of experience and over 350 consecutive case series with long term follow up. Thank you for your question !

William Portuese, MD · Answer

Cheek implants offer a permanent augmentation to the mid-face and cheek area when you're no longer interested in fillers. In our practice, we do not perform fat injections for a variety of reasons which you've  already experienced. Cheek implants are manufactured in a large array of sizes, thicknesses, and shapes which is best determined at the time of the consultation and examination. The implants can also be custom carved as necessary to match patient's unique anatomy. The implants themselves are placed through an intraoral approach under a brief general anesthesia as an outpatient procedure which takes approximately 30 minutes. For more information, many examples and our current price list, please see link and the video below

John A. Standefer Jr., MD, FACS · Answer

The obvious answer to your question of what to do for flat cheeks is to add volume. If fillers are not an option, then cheek implants are your answer. There are malar, submalar and combined implants. The choice can be discussed during an personal consultation. Cheek implants can be inserted using local aesthesia with oral sedation. The limitation is the position of the infraorbital nerve which limits the extent of volume improvement that can be accomplished nasally. A tear trough implant or auxillary filler may be required to completely fill the entire cheek. Discuss your options with your surgeon. My Best!
John Standefer MD

What can be done to weak cheeks? (25 year old female). (Photos)

Answers (12)

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