Cheek Augmentation

What you should know

What Is Cheek Augmentation

Full, defined cheeks are a sign of youth and beauty, but over time the face loses fat, causing the cheeks to become flat and saggy, giving way to a sunken-in look. Although some are born with naturally high cheekbones, achieving the look of sculpted cheeks can be accomplished through both nonsurgical and surgical treatments that focus on restoring plumpness, volume and definition. To restore volume to the midface and recreate youthful contours, your doctor may suggest facial implants, fillers or fat grafting.


Fat grafting and transfer

Using your own fat (taken from another part of the body, like the hips or butt), your plastic surgeon can give you fuller, plumper cheeks. Fat transfer is probably the most popular option at the moment for long-term cheek fullness, but using your own fat requires an additional liposuction-like procedure to be performed.

Cheek implants

Along with fat grafting, cheek implants are another option for restoring youthfulness more permanently. Silicone implants, ideal for someone who wants to add a lot of volume as opposed to a slight increase, add fullness and create a lifting effect.

Fillers and injectables

To restore volume lost with age or to provide definition, your plastic surgeon or dermatologist can inject fillers along the cheekbone. While there are a variety of injectables available, different ones produce varying effects—and not all of them last the same amount of time.

“Technically, there are no fillers approved by the FDA for use in this area, but there are several options that are considered to be safe and effective,” explains Plano, TX, facial plastic surgeon D.J. Verret, MD. For temporary correction, Dr. D.J. Verret suggests hyaluronic acid fillers like Restylane and Juvéderm, as well as collagen-stimulators Radiesse and Sculptra Aesthetic (which last longer). 

Fat Grafting

With age, a common change occurs in the malar fat pad, the small area of fat that sits on the cheekbone just under the lower eyelid. “When we’re young, it’s big, fluffy and has structure, like a pillow. As we age, the structure loosens, becomes soft and starts to sag, causing the under-eye area to protrude,” says New York City plastic surgeon Scott Wells, MD.

For areas that have become void of fat and have taken on a hollow and depressed look, fat can be added back. Known as fat grafting, micro-fat grafting or autologous fat transfer, this procedure first involves harvesting fat from one part of the body (like the buttocks, hips or thighs) before it’s processed and then reinjected into the needed areas to add back volume and shape. One of the main benefits of fat transfer is that your own body fat is used, so there is no risk of an allergic reaction or rejection.

And just like how different areas of the body lose or gain fat easily, the same notion applies to the face. “We know that there are compartments of deep fat, which is the second layer of fat responsible for giving structure and fullness, in the middle of the cheeks and under the eyes,” says Littleton, CO, facial plastic surgeon Brent Smith, MD.

Some compartments store fat while others, like the cheeks and eye area, are quicker to lose fat. Dallas, TX, dermatologist Dr. Joel Pessa also points out that when fat is lost from these key areas, along with changes in bone structure, the signs of aging become more evident. A benefit of understanding these fat compartments is that it allows your plastic surgeon to know where to add back fat for the best improvements.

According to La Jolla, CA, plastic surgeon Robert Singer, MD, when fat is transferred to the face, “Thirty to 50 percent of the fat transferred stays permanently. The procedure has been refined since it was initially introduced.” Not only does fat transfer provide long-term results, many doctors favor it for the natural look it gives. “Some reports even show that fat grafting may encourage collagen growth within the tissue,” adds Dr. Brent Smith.

New York City plastic surgeon Andrew Kornstein, MD, points out that it’s a long-lasting option that customizes and sculpts the cheeks into what the patient desires. “Fat grafting not only puts the lost fat back, it also acts as an active stem cell to rejuvenate the skin. The quality of the skin is dramatically better and the pores even look smaller,” he adds.

Cheek Implants - Cheek Augmentation

Cheek implants are a permanent solution to cheeks that have gone flat with age or are hollowed. It may just be that changes in our bones, coupled with gravity and other aging factors, lead to sagging and wrinkled skin. When the skin becomes slack and the bones change in size, the skin and muscles cannot drape over the bone properly. “We really have no idea why facial bones change, but it’s believed that it may be somewhat linked to hormones,” adds Dallas, TX, plastic surgeon Joel Pessa, MD. 

Facial implants, like cheek implants, can be used to add definition back to areas of the face where bone structure has become less prominent. But some doctors, like Newport Beach, CA, plastic surgeon Val Lambros, MD, don’t believe that bone changes are a main component of facial aging. “Unless you’re missing your teeth, the skull only shifts in size by about one millimeter or one-twenty-fifth of an inch,” he says.

Although cheek implants can be shaped, they tend to not create as natural of a look as fat injected into the cheeks.

To determine if a cheek augmentation lift is right for you, it’s important to discuss your concerns with your plastic surgeon >

Injectable Fillers - Cheek Augmentation

Expert injectors are constantly finding new ways to make use of fillers and injectables. “The cosmetic approach to aging and enhancing one’s appearance has changed. It includes going beyond just wrinkles,” says Boca Raton, FL, dermatologist Marta Rendon. “An important part of maintaining a youthful appearance is addressing volume loss. Some of the more popular uses for fillers are revolumization of the cheeks (and lips, filling in under the eyes, improving the look of the hands and earlobes and, of course, minimizing smile lines).”

By using a combination of injectable fillers, your doctor can instantly lift your cheeks and restore lost volume. Thick hyaluronic-acid-based gels like Perlane, and longer-lasting Radiesse and Sculptra, are ideal for resculpting the cheek and building volume. The result, which lasts on average from six months to a year, if not more, is contoured cheeks, giving way to a more youthful appearance.

Both hyaluronic acid injectables and collagen-stimulating fillers can reinstate definition to the cheeks, giving a more defined profile and a similar look to what’s achieved with fat without surgery or the “forever” factor. “Fillers are useful in reestablishing the shape of the cheek around the orbital rim, where the signs of aging often begin. This area should be injected with a deeper technique to reduce the risk of visible irregularities since the skin can be thin,” says New York City plastic surgeon Andrew Kornstein, MD. To get the most natural look that doesn’t look “done” or “injected,” filler should be placed in the front of the cheeks, as opposed to the outside of the cheekbones, which causes the filler to push the eyes up.

“The upper cheeks are an extension of the tear trough area,” says Westborough, MA, facial plastic surgeon Min Ahn, MD. Filler or fat can be used to help lift the outer corner of the cheeks and add volume so that the cheeks and under eye are in better proportion.

Placing Sculptra Aesthetic, a collagen stimulator, in the upper area of the cheek adds fullness and can also lift the area below the cheeks, which may be flat. “By lifting the cheeks, other features are subtly lifted, too, like the corners of the mouth and jawline, which gives a nicer contour,” says Los Angeles dermatologist Rebecca Fitzgerald, MD. Radiesse, Juvéderm and Artefill can also be used to achieve similar results.

Who it is for

If you have one or more of the following conditions, you’d be a good candidate for cheek augmentation:

  • Flat, deflated-looking cheeks
  • Cheeks that lack definition
  • Hollows in the cheeks or temples
  • Under-eye bags or lines and wrinkles on the cheeks

Who It Is Not For

Those who aren’t experiencing deflation or sagging in the cheeks

What to Expect

During fat grafting, which is usually performed under sedation or general anesthesia, your doctor will inject fat taken from another part of the body (like your hips or butt) directly into the cheeks. You can expect some swelling for about 10 days after the procedure, and generally 30 to 50 percent of the fat lasts permanently for a positive change in shape and added volume. Additionally, because it is your own tissue, there's no chance of an allergic reaction or rejection.

In addition to improving the face aesthetically, implants also slow down the effects of how bone ages. If you have strong cheekbones and a prominent jawline, you may age at a much slower rate than someone who has weaker bones. Implants can start making this positive impact as early as one's 20s or 30s.

With fillers, you may have zero to 10 days of recovery time, depending on the filler. You may also experience temporary bruising and swelling. The result, which lasts on average from six months to a year, is contoured cheeks, giving way to a more youthful appearance.

Inside Tips

Here are five top questions you should ask your doctor about fat injections:

  • From where will you take the fat that is to be transferred? Where will the fat be reinjected?
  • Will fat injections alone achieve my goals? Are there alternatives you recommend?
  • How many treatments will I require to achieve my desired results?
  • What type of recovery will I require?
  • What type of anesthesia will be used and who will administer it?

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