20 years old. What causes this 'melting like' folds appearance? What surgical approach could address it? (Photos)

Question

I’m 20, and I’ve noticed that under certain lighting tmy midface looks extremely exaggerated, with very pronounced folds. I’m aware that I likely have a recessed infraorbital areas and a lack of forward projection in my zygomatic region. Right now, I see a few possible explanations: -A lack of forward projection in the upper midface (infraorbital + malar regions), rather than an issue with malar fat -Excess or poorly positioned malar fat pads being the main cause -A combination of both skeletal structure and soft tissue contributing together. Some additional context: my facial fat distribution isn’t great, even at around a true 13% bf I store a-lot of face fat but it's getting increasingly difficult to get leaner to assess bone structure. In terms of solutions, I’ve started looking into options like infraorbital or malar implants, but I’m open to hearing other perspectives on what might be going on and what surgical approaches could address it.

Carl Truesdale, MD · Answer

At 20, soft tissue folds running through the cheek typically come from one of two structural issues, and the right intervention is different from what you'd do in an older patient.
Underdeveloped midface bone. If your cheekbones are relatively flat or your maxilla doesn't project forward enough, the overlying soft tissue has nothing to drape over and creates a fold appearance. Solution: cheek implants or in some cases sliding maxillary osteotomy. Implants are the more common move for cosmetic-only concerns and give a permanent structural change.
Heritable soft tissue pattern. Some patients are born with redundancy in specific areas. This isn't aging, it's anatomy. Solution depends on which compartment. Sometimes selective filler to camouflage, sometimes a small targeted surgical adjustment.
What's almost certainly NOT the right answer at 20:
A facelift. Facelifts treat tissue that has descended over time. At 20 the tissue hasn't descended, so a lift would create unnatural tension without solving the underlying issue.
Aggressive buccal fat removal. The fat in your cheek hollow plays a role in long-term facial volume as you age. Removing it now usually creates a gaunt appearance in your 30s and 40s. I see a lot of regret cases from this exact decision.
What I'd recommend: get a consultation with a facial plastic surgeon who routinely evaluates younger patients for structural augmentation. The exam should include assessment of your bony anatomy specifically. Ask to see implant outcomes in patients with anatomy similar to yours. Filler is a reasonable preview if you want to test the look before committing.

20 years old. What causes this 'melting like' folds appearance? What surgical approach could address it? (Photos)

Answers (1)

More Cheek Implants Questions

Wanting a Slim, More Defined Face - Cheek Implant, Facelift, or Something Else? (Photos)

Concern about chin and maxilla (mid-face) projection and profile balance. (Photos)

If I use microcurrent and wanted to get cheek implants would I have to wait for the microcurrent results to revert back first?

How can I restore volume to cheeks after cheekbone reduction? (Photos)

Can bone erosion be caused by screws being removed?

Lack of mass in my midface region - How to tell if I need fat grafting or custom implants? (Photos)

WE SEND PRETTY
EMAILS