Loss of Fat in Cheeks, Wanting Perlane, Any Advice? (photo)

I'm only 27, but 28 in April. From fluctuating weight for all these years, my cheeks look deflated and saggy. Could Perlane Help? I would like upper/mid cheeks and NSL Folds. I want my youthful face back!

Doctor Answers 10

Try Ultherapy

I really like Ultherapy in younger patients. While fillers make sense as an annual volumizer and can be very helpful to augment really deflated, sagging areas, I’d rather use a device that triggers your own tissue to rejuvenated. Micro-columns of targeted ultrasound work to tighten underlying subcutaneous tissue that lifts and tighten. Why use an outside material when your own body can do it with the right stimulus?

New York Dermatologist
5.0 out of 5 stars 7 reviews

Perlane in cheeks

Thank you for your question and photo.  You are an excellent candidate for Perlane, as you have mild mid-face volume loss.  There certainly are alternative "volumizers" and collagen stimulators available, but I think that Perlane would be a good starting point for you.  If you like the result, you can always choose a longer-lasting filler in the future.

Jordan C. Carqueville, MD
Chicago Dermatologist
5.0 out of 5 stars 5 reviews

Filler in a 27 year old

Thank you for your question. The factor that needs to be considered most of all is the contour of your face, not your age. You do have some volume deficiency between your "cheek bone" and the fold outside of your smile lines, called the nasolabial fold. Your deficient area is called the tear trough or nasojugal groove. Perlane, if injected judiciously, can give a very nice result. Other excellent products are Sculptra, which will last considerably longer and Juvederm Ultra Plus, which will last about a year in that area.

All in all, any filler would result in an improvement if done properly. Actually, the injector is more important than the specific product, so be sure you find someone with lots of experience and skill in facial volumizing.

Ultimately, you may want fat transfer, which will last for years, or even an implant for this area for permanent results.

Good luck with your injections.

E. Ronald Finger, MD
Savannah Plastic Surgeon
4.8 out of 5 stars 81 reviews

Perlane and volume loss

You aren't too young to receive injections for facial volume loss and from the photo you've posted, you are likely an ideal candidate for Perlane injections to the upper cheek area. Be sure to visit a well-trained and experienced provider for a full assessment.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews


Your photo does show a significant amount of volume loss for your age in the malar (cheek) area.  I personally prefer to use a volumizer, such as Sculptra, to help rebuild the volume to this area of loss.  With an experienced injector, your results will be very natural and results typically last up to two years.  There are other options as listed previously.  I recommend you schedule a consultation with an experienced injector to discuss your options and then you can make an informed decision that best suits your needs.

Cheryl A. Hull, MD
Rogers Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Loss of volume in cheeks

Many patients with extreme weight fluctuations will have volume loss - and more profound than other people their age. This is why you are experiencing this significant volume loss at a younger age than would be considered "normal". Fillers work well in the cheeks - upper malar injections - done by an experienced injector - can help alter your volume so that you may not even need much in your NLF lines. I would suggest meeting with a board-certified injector to discuss your options. Fat grafting, other filler types, and implants are also options. But I do thing Perlane could be a good, soft, viable solution for your specific needs.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

How to restore volume in the cheeks

Deeper stimulatory fillers such as Sculptra or Radiesse, when strategically injected high along the cheekbones and lateral face, will create a much better lifting effect for sagging skin than the other fillers. Sculptra or Radiesse are best for treating volume loss and leads to the natural-looking results that are so often desired. Patients don’t want to look “done” but also don’t want to look “tired”. Seemingly small changes in shape, proportions, balance, and symmetry can have a surprisingly large effect on our perception of the aging face.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

Loss of Fat in Cheeks, Wanting Perlane, Any Advice? (photo)

You stated the better treatment in your question, "fat" grafting would be excellent choice for your issues. Seek some in person evaluations from boarded PSs in your city. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews


Looking at your photo it appears that you are correct that you have lost midfacial volume -cheeks.  Whether you are a candidate for Perlane depends on your medical history and a complete examination.   Perlane can be used to provide mid facial augmentation.  In your photo it appears that your volume loss extends towards your lower eyelids into a region commonly called the tear troughs.  Rather than Perlane frequently Restylane can be used in this area.  It should be noted that using Perlane or Restylane in these areas is FDA "off label."  If your weight has been fluctuating significantly or you have been losing significant amounts of weight it is best that you see your primary care physician for evaluation before having any cosmetic procedure.

Paul Carniol, MD
Summit Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Loss of Fat in Cheeks, Wanting Perlane, Any Advice?

 Aesthetically speaking the cheeks are a bit flat anteriorly.  Perlane injections can shape the cheeks as can Cheek Implants for a permanent augmentation.  Be sure to select an MD that understands and follows the proper aesthetics of facial beauty for the creation of a naturally more attractive face.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 26 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.