Solutions for Hollow Cheeks?

What can be done about indentations in the skin directly under the cheekbones that give an aged appearance?

Doctor Answers 12

Hollow Cheeks

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it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.

In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.

In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 121 reviews

Fat or implants

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As we age several things happen to cause the aged look. First, gravity moves the soft tissues, skin, fat etc. down toward the jaw line. This is why we get jowling. The soft tissue of the cheeks is actually located on the lower side of the cheek bone and as it falls the cheek bone is accentuated thus giving that depression. In addition we lose fat as we age.

So my first recommendation would be to add fat to your cheek and midface region with fat grafting. This usually takes more than one procedure but is very successful. The alternative is a solid implant that can be carved to help this area. The problem with implants is that if the tissue over them is thin they can be visible.

So try fat grafting first.

Many options for cosmetic cheek plastic surgery

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Plastic surgery patients have many options for sunken, hollow cheeks and the midface area. Although age and sundamage are the biggest contributing factors, many patients on HIV medications have a condition called facial lipodystrophy, which also causes hollow cheeks.

Regardless of the exact method, the aesthetic treatment is for cheek indentations is augmentation. Fortunately, one has many options to add volume to sunken cheeks. More temporary injectable fillers, such as Restylane, Juvederm, and Radiesse, last several months by augmenting the skin. The cosmetic facial treatments must be repeated, but injections are simple office procedures with little downtime. Injectable fillers are more affordable.

Another injectable solution is Sculptra. It's a material which is injected much deeper into the face and stimulates fibrous tissue over time. Results are not immediate, but rather develop months after treatment, but last much longer. Patients usually require more than one treatment for the desired cosmetic effect.

The more popular solution for injection is fat from you own body, performed either under local or general anesthesia. Fat injections have the possibility for long-term natural results. Some touch-up injections may be necessary, but may be performed in the office.

The most permament solution for the cheek is enhancement with a silicone implant. Cheek augmentation with implants is performed under IV sedation or general anesthesia via a small incision inside the mouth. There is more swelling and bruising as compared to the other techniques, but results last much longer.

Lastly, a combination of various volume enhancement solutions may be performed at the same time. Speak with your facial plastic surgeon to discuss cheek augmentation to find a cosmetic treatment which is appropriate for you.

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

Juvederm great for hollow cheeks.

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You sound like an ideal candidate for non invasive cheek augmentation with skillfully applied Juvederm under the skin.  It lasts nine months or more.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Non-Surgical Cheek Augmentation: The Quick and Easy Fix for Hollow Cheeks, Dents, and Creases

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A rounded contour to the area over the cheek bones with an outward flare of the cheeks toward the temples that trails off like the tail of a comet along with a fullness below the eyes in the region closest to the nose are essential elements of the youthful and sensuous central face. Dents, creases, hollows and loss of convexity anywhere in this area signal aging.

Cheek implants are of course one possible surgical solution. The use of fillers and volumizing agents, a totally non-surgical approach, is another. The latter, my personal treatment preference, allows for continuous "sculpting" and shaping of this region over time as loss in volume and gravitational changes continue their inexorable course.

While hardier hyaluronic acid products, such as Perlane and Juvederm UltraPlus, have been used successfully for cheek augmentation, I prefer Radiesse for this facial unit. Composed of calcium hydroxylapatite, a moldable, viscous, bone-like material, Radiesse can be easily contoured and draped over the underlying cheek bones and provides sufficient volume and lift to sunken areas nearby.

Additionally, it has been approved by the FDA to be mixed with a small amount of local anesthetic, which makes the twenty to thirty minute procedure relatively painless.

Since it is a semipermanent volumizer, results can be expected to last between 1.5 and 2 years before a touch up is needed. The results of non-surgical cheek augmentation typically prompt a "Wow!" response from patients when handed a hand mirror right after treatment.

Mild bruising, swelling, tenderness may follow and last for a few days, but most people return to their daily routines immediatley following treatment or the following day.

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

Cheek implants are a good solution

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Aging cheeks and indentations in the cheek area can be augmented very nicely with a small cheek implant placed in the gingival sulcus on the inside of the upper lip. These come in different sizes depending upon the patients’ needs, wants, and desires. It can also be removed or exchanged if needed.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Cheekbone area hollowness

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On a temporary basis, fillers can be used. The safest are hyaluronic acid based such as Juvederm or Restylane.

On a more permanent basis, fat injection or autologous grafts may work well. In our practice we use LiveFill (TM) extensively, non-traumatized fascia fat grafts (no dermis).

If volume has slipped south and the skin has become lax, a volume adjusting multivector facelift may give the best long term result.

In any event, you may want to partner with a surgeon who can consider the face as an artistic whole, over time, to get your best result given your needs.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 191 reviews

Hollow Cheeks!

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Dear Sus, as you can see there are many options. Things to consider are the longevity of the solution, possible downsides, recovery, cost , and other adjunctive procedures- whether they are surgical or non surgical.

The key with any of the procedures is that the result looks 'natural' and does not have long term risk.

With Warm Regards,

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Many potential options for cheek augmentation

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This question has been well addressed and any filler (commercially available or autologous grafts) can essentially be used.:

  1. Radiesse
  2. Juvederm Ultra or Ultra Plus
  3. Restylane or Perlane
  4. Sculptra
  5. Autologous fat injections or dermal-fat grafts
  6. Implants (silicone, polyethylene, PTFE, polypropylene, hydroxyapatite, etc)

Depending on the volume required, some may be prohibitively expensive for the volumes required and for maintenance.

Also take into account your personal health and fluctuations in weight which may have an effect on the long term results.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Different fillers for hollow cheeks

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Injection with fillers is the most practical and efficient way. Different filler materials are available. Fat grafting is one of the most efficient fillers as long as it is injected in the right plan.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 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.