Fat transfer instead of cheekbone implants? (Photo)

Dear teawaterThank you for your question!The facial contour can be changed with the removal of fat when it is too prominent and micro fat grafting to add contour where it is needed.I have seen cases similar to your photo- ( hard to tell exactly!) and the nice part about these procedures is that it would be hard for someone to tell that you have done something.With Warm RegardsTrevor M Born MD

You are quite right in your observation that the fat appears to be in all the wrong places. In youth there is a heart-shaped, robust, outwardly projecting (convex) fat pad situated about 3mm below the lashes of the lower lid , which sweeps medially toward the upper inner cheek (near the nasal bride) and outward toward the crow's feet region. After age forty, this fad pad shrivels and shrinks and falls southward and inward. The remnant of this fat pad, now somewhat triangular in shape (the area circled in yellow in your photo), now pushes downward and inward to create the deep smile furrow seen. In addition, its absence from its former higher up location contributes to the flattening of the cheeks and hollowing under the eyes.With this in mind, volumizing fillers, are now used to augment the cheeks and create high cheek bones, restore the convexity and robustness to these regions, and secondarily (i.e. without actually needing to directly inject them) to diminish the smile line folds and even the marionette lines to the sides of the chin. I am not much of a fan of fat transfer, which I stopped doing around two decades ago. Despite what you may have heard or read, fat does not necessarily last much longer than today's volumizers, such as Voluma XC, which I use in my Upper East Side Manhattan office for this purpose. (In my Israel satellite office, where a far greater number of regulatory agency approved fillers and volumizers are available, I prefer Emervel Volume). Fat transfer requires two procedures, one to withdraw the fat and the other to inject it using large bore cannulas, and is generally considerably more expensive and time consuming and the fat injected, which retains its ability to grow with weight gain, may present problems years down the road if it should persist.Consultation with a board certified aesthetic physician with extensive experience and expertise in cheek augmentation is strongly advised.

Thank you for posting a photo. I recommend
consulting with your doctor and ask about Voluma for the cheeks. Voluma is a
facial filler that will instantly volumize the area that has lost volume over
time. Results lasting up to two years will give you a younger and fresher look.
Good luck!

Teawater, There is an operation which I do called "Somme Lift" (sub orbital mimetic muscle elevation) which lifts the upper face and cheeks to give a very much shift of your facial soft tissues upwards. Sometimes I also recommend small cheek implants to give an even more accentuated look depending on how the patient wants to look after I consult with them. In order to do the best for the patient I require photos of other women's faces that look similar to the way the patient wants. I also do a computer image face change on the patient when they come in to consult. All of this helps a surgeon to improve the patients face as close as possible to the way they wish. Best, Dr. Terino

There are several ways to plump and lift your cheeks. As you suggested, use of an implant and fat-grafting are good options. Fillers are another option that can be used to plump up these areas. I feel that fat grafting and fillers give a more natural look. If you want to try out a new look with out making any permanent decisions, HA fillers (such as Voluma or juvederm) are a good first choice. The fillers can be injected into the cheeks to give you a nice lift, this also improves the appearance of the Nasal labial crease. Fillers usually last 1 1/2- 2 years in this area. If you find you do not like the look, the fillers can be dissolved with another injection in the office. A more permanent option is to use your own fat to plump and lift the area. This fat is harvested from another area of your body, purified, then injected into the cheeks. About 10-40% of the fat will be reabsorbed by the body. Typically this is why surgeons "over-fill" the area of fat-grafting to ensure the desired result is achieved. Hope this helps. 

I believe removing the fat in your nasolabial fold and adding cheek implants to give you soft, apple, feminine cheek is the best answer for you!  I do not perform fat transfers to the cheek area, as I believe the implants are much more beautiful