Upper molar removed - asymmetric cheeks. Fat transfer or filler, to get result I'm looking for? (Photos)

Question

I had to get an upper molar removed. It caused one cheek to be more sunken then the other. See photos. First photo shows the sunken apearance. The second shows the result I'm hoping for. I do not want volume on my cheekbone or jaw. Just that one small area of my lower cheek. Where the red arrow is. Would filler migrate? Or is fat graft best?

Carl Truesdale, MD · Answer

Removing an upper molar can change cheek volume because the soft tissue that was supported by the bone and underlying tooth now has less structural backing. The asymmetry you see is usually a combination of bone loss in the alveolar ridge and overlying soft tissue collapse.
Treatment options:
Filler is the most common starting point. HA filler placed deep against bone in the affected cheek can restore the missing volume. Lasts 12 to 18 months and reverses if you don't like it. Good first move because it lets you preview the look.
Fat grafting is the more durable option. Your own fat is harvested from another area and grafted into the affected cheek. Retention is typically 50 to 70% at 6 months, so often slight overcorrection is needed. Result lasts much longer than filler.
Cheek implant is the surgical option for significant or permanent correction. Used less often for dental-related asymmetry because the bone is normal everywhere else. Reserved for cases where filler and fat grafting aren't satisfying.
Dental restoration also matters. If you haven't replaced the removed molar with an implant or bridge, the underlying bone continues to atrophy and the soft tissue keeps collapsing. Addressing this with your dentist or oral surgeon prevents further asymmetry.
What I'd recommend in your shoes:
Talk to your dentist about restoring the missing tooth structurally. This is foundational.
Then consult with a facial plastic surgeon or injector about volume restoration on the affected side. Start with filler if you want a reversible trial. Consider fat grafting if you want durability.
Photos in consult should be from multiple angles, including from below, because cheek asymmetry can read differently depending on the angle of view.

Tim Neavin, MD · Answer

Thanks for sending your photos. I see exactly what you're referring to, and I agree that this is an area where a little additional volume could make a meaningful difference.

Personally, I would favor fat transfer over filler. Filler can migrate, and in an area like this, repeated injections can sometimes create fullness where you don't want it. Fat transfer allows us to restore volume very selectively, with results that can look incredibly natural and last for many years.

And I agree with you about not wanting to add volume to your cheekbones or jawline. Neither is necessary if the goal is simply to soften that small depression and improve symmetry.

One thing I'm curious about: Do you have plans to replace the missing molar with an implant? I ask because losing a tooth can lead to changes in the underlying bone, which may contribute to the hollowing you're noticing. I'd want to understand that before deciding exactly how to approach it.

Fat transfer is particularly well suited for this type of subtle facial balancing, but the technique makes an enormous difference. Everything from how the fat is harvested and handled to the instruments used, the depth of placement, and the amount transferred matters. I also pay close attention to nutrition before and after surgery to help create the best conditions for healing and fat survival.

Assuming this is primarily a soft-tissue volume deficiency, I think a small, carefully placed amount of fat could make a beautiful improvement without changing the character of your face.

The goal isn't to make your cheek fuller. It's simply to make that hollow less noticeable so both sides of your face look more balanced.

Waylon Zeng, MD · Answer

Hi there thank you for your question and sharing your photos. I'm sorry the molar extraction left you with a contour problem with your cheek! This is likely due to bone resorption after the molar was removed. When a tooth is removed or fallen out, the jaw bone no longer has something to support, and so it will deteriorate. this is likely what is being seen in the area you marked red. So there is actually nothing wrong with the soft tissue, fat, muscle in the cheek. Its the loss of the bone structure. This would honestly best be treated with bone grafting and then a tooth implant in that area. That way, the bone will be reformed and properly supported to maintain good cheek projection. This is a difficult area to inject filler, as it will migrate and will not push out against the skin. Hope that helps!

Yily De Los Santos, MD - Account Suspended · Answer

Based on your description, it sounds like you are looking for a very subtle correction in a localized area of the lower cheek rather than overall facial volumization. Both filler and fat grafting can improve this type of hollowing, but the best option depends on how much correction is needed and whether you want something temporary or longer lasting.

For a small, precise area like the one you described, filler is often a good first step because it allows controlled placement and adjustment with minimal downtime. When performed conservatively and in the correct plane, migration is less likely. The key is choosing an experienced injector who understands facial balance and restraint, especially since you do not want additional volume in the cheekbone or jawline.

Upper molar removed - asymmetric cheeks. Fat transfer or filler, to get result I'm looking for? (Photos)

Answers (4)

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