Sunken Cheeks: Long-lasting Dermal Fillers Available?

Having used both restylane and perlane, with passable results, I am now searching for something longer lasting. A filler that lasts longer than 6 months ? I lack ''fullness'' in the face, especially around the nasal folds, I would describe it as ''sunken'. Should I consider a sculptured effect and have the Dr. '' fill out'' the sunken look, by filling out the cheek area to ''lift'' the folds ? Sadly, fat implants are not an option here. It's so confusing, and even though you do the research, you are still left wondering which product ! I have also had 2 sessions with fraxel laser, which, truthfully did not do what I expected. I am slim petite frame and face, and coming up to the big 50 I just feel I look gaunt. Hope this gives you clear picture. Its not easy to describe oneself, and of course I have to temper my expectations ! Miracle cure, I live in hope. Thank you for your time.

Doctor Answers 19

There are filler options that last longer

Mid-cheek atrophy can make you look gaunt and tired. Patients often feel that their face looks sunken and that the cheeks appears to sag.

I have found very good longevity with Juvederm Ultra Plus to correct this problem. It must be injected under the muscle and angled so the cheek is raised immediately upon injection. Patients typically have results that last 9-12 months.

I also have used Radiesse and found similar longevity and, in fact, it can last more than a year in some patients.

Sculptra is fabulous for some patients, lasting 2 years or more, but it requires more injection sessions and often takes 3-6 months for the full effect to be achieved.

Artefill is a permanent implant for the nasolabial fold, but has not been used much for mid-cheek atrophy. It might, however, be useful for severe cases.

Finally, I've had success with some tightening and lifting of this area with Titan in younger patients (under 50). Fraxel is very good for texture, lines, discoloration, and scars, but does not lift very well.

It is always best to discuss options with an experienced and reputable board certified dermatologist or plastic surgeon who will lead you to your best choice and explain all the risks and benefits.

New Orleans Dermatologist
5.0 out of 5 stars 13 reviews

Sculptra for Sunken Cheeks

You sound like a perfect Sculptra candidate.

Fillers do go away in months and if you need considerable "plumping" the cost of repeating temporary fillers can get very high.

Sculptra was originally approved in the US for treating lipo atrophy in patients with HIV over 5 years ago. Lipo atrophy (or fat wasting) is not a problem only for those with immune deficiency, but also for some with high metabolism, from weight loss, or just genetics predisposition.

Sculptra is injected in such a way to restore volume in nearly any area of the face. Done well, you can fill out the central face, cheek areas, temples and the fill effect from above can "lift" the jowls.

The volumizing effect comes from your own collagen since Sculptra's job is to activate new collagen production. Obviously your own collagen will be less prone to breakdown than a gel filler. Many patients enjoy prolonged volume improvements of 2 years or more....this is all dependent upon your own body's system and health, but you should certainly expect a good 18 months.

I was fortunate to begin working with Sculptra while it was being investigated years ago. My patients in the Los Angeles clinic were thrilled to "get their face back". The work and research opportunities I've had led to my becoming a trainer for Sculptra and I love seeing what it can do for such a wide variety of people.

Rebecca Fitzgerald, MD
Los Angeles Dermatologic Surgeon
4.0 out of 5 stars 21 reviews

Fat Grafting Can be Ideal for Sunken Cheeks

my Raleigh, North Carolina Plastic Surgery Practice I use Fat Grafting to treat sunken cheeks. There are a number of 'soft tissue fillers' are available for temporarily improving facial areas that have lost volume or have developed deep lines and creases. Probably the most popular fillers currently are hyaluronic acid products like Restylane, Perlane or Juvederm which can be used to plump up thin lips and to fill out nasolabial folds (lines that run from beside the nostrils to the area beside the corners of the mouth) and marionette lines (lines that run from the corners of the mouth towards the jawline). The improvement generally lasts about 6 months and can last up to a year. I regularly use Juvederm, Restylane and Perlane in my Raleigh, North Carolina plastic surgery practice to fill lines and plump lips
For patients seeking permanent enhancement of soft tissue volume, the ideal material to use would obviously be something that is naturally-occurring and not rejected by the body or treated by the immune system as a foreign material. Whether the goal is to restore volume to an area such as the lips or the cheeks, or to fill in a crease or depression such as the nasolabial folds or marionette lines, the ideal material is quite clearly the material that one wishes was there in greater abundance in the first place: YOUR OWN FAT.
A relatively new technique has been developed called structural fat grafting, in which small amounts (less than 0.1 cc at a time) of fat are carefully microinjected in a series of discrete layers to gradually 'build' new soft tissue structure. As there is space between each microinjection, new blood vessels are able to grow into the grafted fat, allowing it to persist. If this process of blood vessel ingrowth (neovascularization) does not occur, then the injected tissue cannot truly be considered a 'graft' and is instead just another 'soft tissue filler' of limited duration.
This is a procedure that requires specialized training and specialized surgical instruments, as well as patience and attention to detail on the part of the surgeon. When performed properly, permanent improvements in facial plastic surgery are possible.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 97 reviews

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Cheek deflation causes sagging of the cheeks and deepening of the nasolabial folds.

One has to understand the aging process of the mid face in order to correct the sagging that you see in your cheeks.  This sagging also is the cause for the deepening of the parenthesis (nasolabial folds).  All to often, plastics surgeon go after these folds, filling and unnaturally effacing what we were born with.  They are treating the symptom, not the cause- the loss of cheek volume.  I have patients bring in photos from their 20's and 30's to demonstrate this change in facial volume which can involve the cheeks, under the eyes, temples, and jaw line.

There are many options for restoring youthful volume to the cheeks.  If you are looking for instant results, that can last 6 to 12 months, usually a combination treatment of Radiesse, Juvederm, and Restylane injections work the best.  Many patients want longer lasting results, that are instant, without downtime.  The safest product, is Juvederm Voluma, which can last up to two years.  It is the only FDA approved injectable filler for the cheeks.  Many patients opt for Sculptra injections because the results develop gradually over time, are natural, and last more than two years.  Surgery is always an option, including fat injections and cheek implants.  There is up to two weeks of downtime but when performed well, these results are also very rewarding.

Ran Y. Rubinstein, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 146 reviews

Consider fillers a "trial" - you may want malar implants

If you were happy with the results of injectables and used them to achieve full cheeks, it might be wise to consider malar implants. Cheek implants augment the bone structure of your midface and both add volume and strength to your malar region. For patients who are unsure about malar implants, I offer temporary fillers, but once you have had a filler and liked the result, it is much more cost effective to switch to implants.


Alternate Options - Cheek Implant ot Fat Injections

Hello in Hong Kong,

Execellent answers to your questions from Dr. Lupo.

As a Surgeon I did want discuss two other options that you may find helpful.

You mentioned that fat implants are "not an option here". Is that for medical reasons or lack of experienced provider? For discussions sake, fat injections are a safe and effective way to restore volume to the face. Like some of the fillers multiple injections may be required to get the desired effect but the end results are worth it. This is becoming an increasingly performed procedure so maybe with time an expert will be available in your area.

I would also recommend cheek implants based on the description of your face. If your face is "sunken" and you look "gaunt" then a cheek implant is a very effective way to restore structural volume to the areas that look sunken. The procedure is simple and can be done with local anesthesia. The implants provide an effective and permanent way to "lift up" and support the sunken tissues. The nasolabial folds are also softened and the midface has a more youthful, rounded appearance.

Best of luck to you!

Kamran Jafri, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Long lasting volume

Don't worry! There is hope!
I like to start with Juvederm to make sure that the patient likes my aesthetic sense before I do something more permanent.
Once we have established that we are on the same wavelength, I like fat transfer for a natural, youthful result. 
With that said, sometimes women not only need more fill in their face, but a lift as well. If you are nearing 50, it may be that time. But it would be difficult to say without seeing you in person. Consult with a board certified plastic surgeon to explore your options. Good luck on your journey!

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 42 reviews

Treatment for sunken cheeks

The treatment for sunken cheeks can involve either temporary fillers or permanent cheek implants. Most of the temporary fillers will only minimal last upwards of one year. Permanent augmentation cheek implants are inserted through an intra-oral approach under a brief general anesthetic, directly over the bone to give the added augmentation. Cheek implants are manufactured in a variety of sizes and shapes( malar and submalar) which is best determined at the time of the consultation and examination. For many examples, please see the link below to our cheek implant photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.5 out of 5 stars 107 reviews

Fat transfer for sunken cheeks

Fat transfer is an excellent option for long term correction of sunken cheeks and a great alternative to temporary fillers like Restylane, Jeuvederm and Sculptra. 

Fat Transfer Results Are Long Lasting


Fat Cells that survive the transfer process continue to live like other fat cells. Therfore the results are long lasting. The problem is not all transferred fat survives the process. In the face more than 75% may survive and more than 60% in the buttocks.. Of most interest is that the fat that does survive behaves as if it was still in the donor site. Therefore as the surrounding native fat tends to atrophy the transferred fat will not. Over time you will notice that the area may not be as full as it once was, but more than likely it is because of the native fat atrophy rather than the transferred fat.


Fat Grafting Results Permanent improvement in most cases. Micro fat grafting, also called structural fat grafting involves multiple injections of very small amounts  of fat injected in a series of discrete layers to allow for better revascularization and "take", gradually increasing the volume of  new soft tissue. My experience is that it is a great minimally invasive procedure for cheek augmentation.


Fat Cells that survive this transfer process continue to live like other fat cells. Therefore the results are long lasting. The problem is not all transferred fat survives the process. In the face for example it has been estimated that up to 60%  or more will survive in the cheek region. Of most interest is that the fat that does survive behaves as if it was still in the donor site. Therefore as the surrounding native fat tends to atrophy the transferred fat will not. Over time you will notice that the area may not be as full as it once was, but more than likely it is because of the native fat atrophy rather than the transferred fat.




Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 104 reviews

Long lasting facial filler

Yes you do have options other than Restylane/Perlane fat injections.

Sculptra an injectable similar to absorbable suture material is an excellent option for augmentation of the cheeks, infra orbital hollows, temples and marionette lines.  Besides lasting two years two to three treatments will improve the look and feel of the overlying skin.

Artefil another good injectable also relies on your collagen stimulation to augment these areas safely and for many years. Cheers

Luis A. Cenedese, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 17 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.