Hollow Cheeks – Treatment with Implants, Fat Transfer, and Fillers
What Causes Hollow Cheeks
The aging, hollow face is typified by soft tissue decent and volume loss. These stigmata of growing older are manifest by the development of nasolabial folds, marionette lines, and jowls combined with a sunken mid-face and hollow cheeks.
In recent years, DeLuca Plastic Surgery has looked past skin tightening as the solution for all of these complaints and has recognized the role that volume loss contributes to the appearance of aging, hollow cheeks. This volume loss occurs as the soft tissue (and even bone) of the face resorbs over time as we get older or secondary to weight loss. To combat these changes we utilize a variety of techniques including several types of non-invasive facial fillers, fat transfer, and facial implants.
Projection of the cheeks and mid-face is due to the interaction of the bones of the face and the overlying skin and soft tissue. Facial implants are used to add a more substantial foundation to hollow cheeks by adding projection to the bones of the face in patients that have experienced significant resorption as they age or who have always lacked projection. Skeletal implants are powerful tools to modify the framework of the face and can produce dramatic results. In our practice, these implants are often combined with soft tissue augmentation, such as fat transfer, to treat hollow cheeks – restoring harmony and symmetry.
Facial Fat Transfer (Grafting)
Fat transfer is a surgery by which fat is injected into the face to add volume to hollow cheeks and give the face a lifted, fuller, and more balanced appearance. The procedure takes place in the operating room under general anesthesia or mild sedation and starts with liposuction of the abdomen or thighs to harvest the fat needed for the transfer. This procedure is performed through multiple small “stab” incisions using a fine cannula.
The collected fat is carefully filtered to remove impurities and transferred to syringes. Dr. Tauber then injects the fat into the face using a blunt cannulas into the deep fat compartments of the cheek. Fat grafting is also performed by itself or in combination with a facelift or blepharoplasty.
For patients that are looking for non-surgical approaches to fight the volume loss associated with aging, hollow cheeks, recent advances in facial fillers have offered alternatives to the knife.
Fillers are a type of injectable gel used to replace or add volume to the face in an effort to make hollow cheeks look fuller and, thus, younger. Fillers are also used to camouflage wrinkles or depressions. Treatment areas most often include the nasolabial folds (between the nose and the corners of the mouth), the marionette lines (between the mouth and the chin), the cheeks, and the area around the eyes.
Hyaluronic Acid (HA) filler is one type of this gel. The filler adds volume to the face directly and by recruiting water to the tissues. Hyaluronic Acid comes in different formulations.
Thinner formulations such as Juvederm Volbella or Restylane Silk are used more superficially (at the surface of the skin) to fill fine lines (such as acne scars and smokers lines around the mouth) and restore volume of tissue with thin skin (such as around the eyes). Moderate thickness fillers such as Juvederm Ultra And Restylane L are used just under the skin to add volume to camouflage larger wrinkles (such as the NLF or marionette lines), plump the lips, and add volume to the lower face. Thicker fillers such as Restylane Lyft and Juvederm Voluma are used to in the deep tissues (often close to the bone) to restore volume to the mid-face and to provide a structural base on which thinner fillers can be layered.
The restoration of volume to aging, hollow cheeks often requires a combination of techniques including facial implants, fat transfer, and fillers. These techniques are often combined with skin removal surgeries such as a facelift or blepharoplasty in a wholistic approach to facial rejuvenation.