Volume Loss Under Eyes and Cheeks. Have Tried Fat Transfer, Restylane, Radiesse With No Results. Other Options? (photo)

I have a dent in the middle of my cheeks and volume loss under my eyes. I am a white 30 year old male 5'5 and 135 lb. I have tried fat transfer four times with very minimal results. I am a little discouraged and I am not sure if I should try fat transfer again or proceed with other options. I have also tried Restylane and Radiesse but I do not see volume being added. Any suggestions or other options available?

Doctor Answers 11

Photos that include you eyes in the picture would be helpful

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First point to make:  Despite another recommendation made on this forum, you ABSOLUTELY SHOULD NOT HAVE LOWER EYELID BLEPHAROPLASTY.

You have prominent eyes, and a slightly weak orbital rim/midface, which will put you at significant risk of lower eyelid retraction.

I agree that your degree of volume deficiency is not severe. If fat grafting and fillers have not worked for you, then augmenting the underlying bone [rim/cheek implant] would give you a good result. You should be aware, that this implant will change you appearance somewhat, and will be palpable.

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Other options for adding volume to mid face

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After having had as many procedures as you have to restore additional volume to the mid face region, you must be discouraged.  I would suggest trying Sculptra which stimulates your body to produce collagen thereby adding volume to mid face.  If you decide to go this route, see a physician who has used Sculptra for a few years.  The favorable results can last for two or more years.  There is little to no down time with this procedure.  Good luck.

Joseph N. Togba, MD
Oakland Plastic Surgeon

Augmentation Of Volume Loss Of Cheeks And Eyes

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After having tried every injectable filler approach, it may be time to consider another alternative. While there is nothing wrong with another attempt at fat grafting, why would further efforts work when other attempts have not? The other option is actual bone augmentation using implants. These may have to be custom made to fit your unique volume loss needs.

Restoration of cheek volume

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I do not see you as a surgical candidate. While the anatomy of your face isn't your ideal, I do not see a deformity from the posted photos and am unsure that what you are seeking is necessary or appropriate. Someone will always take your money but I would encourage you to seek satisfaction in your life outside of additional procedures at this time.

Volume Loss Under Eyes and Cheeks. Have Tried Fat Transfer, Restylane, Radiesse With No Results.

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After reviewing the limited posted photos I would fly to see Dr Syd Coleman in NYC. The father of modern fat grafting. He can evaluate your issues and determine if additional "correct" fat grafting technique could help. Regards. 

Volume loss/ Hollowness of Under-Eye and Cheeks

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If fat grafting, Radiesse and Restylane did not deliver results, I understand your frustration. Personally, I would have recommend fat transfer or Restylane. I do not think that blepharoplasty or facial implants play a great role for your very particular situation.

Be careful with pursuing other and more aggressive surgical options. At the end, minimal or no improvement are still preferable to post-surgical complications.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 50 reviews

Midfacial Volume Loss

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Fat transfer is very technique and operator dependent.  In the facial aesthetic community, there are "fat lovers" and those who have not bought in.  I am in the latter category.  Fat has inherent flaws as a procedure in the requirement for a donor site, lack of predictability in viability of fat cells, calcifications, maintenance of the "fat gaining" properties of the donor area, etc. For these reasons, I feel Sculptra is a more logical and predictable way to add volume to the face in a gradual fashion.  The only permanent solution is a cheek implant.

When Fillers and Fat Transfer don't work consider an implant.

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Fillers such as Radiesse, Restylane, Jeuvederm, Perlane, Sculptra usually require a few or more staged injections for more permanent results - but you are right none are permanent.

Not sure why you did not do better with the fat transfer procedures. Although there is variable take some always survives in my experience with long lasting to permanent improvement. The procedure however is technique specific, so maybe that is an answer.

For a more permanent solution, consider a cheek or tear-trough implant. The implants are typically silicone or Medpore based and can give lasting result See a board certified plastic surgeon with maxillofacial surgical experience and training.

Vampire Facelift® for Volume Loss Under Eyes & Cheeks

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Being that you haven't had any success with Restylane or Radiesse, I might recommend a non-surgical procedure I perform for my patients at my Manhattan and Garden City, New York offices called the Vampire Facelift®. The Vampire Facelift® is a unique approach to helping you look younger using the natural growth factors in your own blood with a filler such as Restylane or Juvederm performed in a special way. After drawing your own blood, it is processed so the platelets (cells which stimulate collagen for healing) from the other main components of the blood (this is called “platelet rich plasma” or “PRP”)

The platelets are processed and made into a platelet-rich fibrin matrix (PRFM) which becomes a gel. Since PRFM is like a gel, it has similarities to other fillers, and can be used to sculpt the face. When the growth factors activate the stem cells of the skin, then the stem cells generate:

  • New Skin
  • New Blood Flow
  • New Collagen
  • New Tissue

Watch the attached video as I demonstrate the procedure for a patient.


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Without  a proper evaluation, it is difficult to say what would best suit you.  Fillers or fat may be helpful in certain situations.  Good luck.

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.