Why do hollow cheeks develop?
Cheeks can look hollow with age as deep fat in the midface decreases and the bone underneath is gradually resorbed, weakening their support. Because several layers that support the cheeks change together, similar-looking hollows can come from different kinds of tissue loss in different people.
Not all hollow cheeks are caused by aging, however. Some people naturally have little facial fat and look lean overall. Others have hollow cheeks while fat remains in the buccal area or jowls, so hollow and sagging areas appear at the same time. That is why I do not choose a filling treatment from the hollowed appearance alone.
How can I tell whether my cheeks are hollow or sagging?
A face hollowed by volume loss needs filling, while a face that looks saggy because it carries more fat needs fat reduction or lifting to be considered first. When both overlap, the hollow area needs filling while areas that retain weight, such as the buccal area and jowls, need separate reduction or lifting.
| What you see | First approach to consider |
|---|---|
| The cheek is visibly hollow from volume loss | Fill the hollow area |
| Fuller cheeks or tissue above the nasolabial folds makes the face look pulled downward | Reduce fat or lift the sagging layer |
| The cheeks are hollow, but the buccal area and jowls are sagging | Fill the hollow area, and separately reduce or lift the remaining fat and sagging tissue |
All three can look similar from the outside, but separating the subcutaneous fat layer from the deep fat layer can reveal something different from what you expected. An in-person examination gives a more accurate sense of whether hollowing or sagging is the larger issue. If the whole face is naturally lean and has little fat, lifting alone will not restore the missing cheek volume, so volume replacement needs to be considered separately.
How do I choose among hyaluronic acid filler, Sculptra, Radiesse, and Juvelook for hollow cheeks?
For hollow cheeks, the choice among hyaluronic acid (HA) filler, Sculptra, Radiesse, and Juvelook depends on the width and depth of the hollow, the thickness of the cheek skin, and how quickly you want to see a change. Even with the same concern, I do not use the same treatment for a face with one narrow, deep line in the cheek and a face where the whole cheek is broadly hollow and the skin has thinned.
| Shape of the hollow and desired change | Treatment to consider first |
|---|---|
| One narrow, deeply indented line within the cheek | Hyaluronic acid (HA) filler |
| You want the hollow cheek to look filled immediately after treatment | Hyaluronic acid (HA) filler |
| The whole cheek is broadly hollow and the skin has thinned | Sculptra |
| You are comfortable with a broad cheek hollow filling gradually over several months | Sculptra |
| The cheek skin is thick and the hollow needs immediate structural support | Radiesse |
| Cheek texture and thinning skin concern you more than the lost volume itself | Juvelook |
I also do not fill the entire face with a single product. When different problems overlap, treatments can be divided: Sculptra for a broad hollow, for example, with hyaluronic acid (HA) filler added to a narrow, deeply indented line. Even when Sculptra suits a broad hollow, I recommend adding filler if an immediately filled-in change is needed. When Sculptra results appear and how long they last covers whether one Sculptra session is enough or several are needed. How Sculptra differs from Radiesse, Juvelook, and filler compares their composition and how they work.
How much filler should be used for hollow cheeks, and what happens if they are overfilled?
Hollow cheeks should not be filled until the whole face looks plump. They should be filled only until the area causing the hollow blends naturally into the surrounding cheek. With hyaluronic acid (HA) filler, identifying the points that create the hollow and placing small amounts can fill only those areas while leaving the rest of the face unchanged.
Too much filler, or filler placed in the wrong layer, can make the cheeks look swollen and round, creating the so-called dumpling-face appearance. After a good initial result, adding a little to different areas every few months can also keep building up across the whole face, even if each amount is small. The most natural-looking faces I have seen were generally those where only the hollow areas were filled and treatment stopped there.
With Sculptra, I also do not decide on a large number of vials from the size of the cheek hollow alone. Checking the change after one treatment and adding more only if needed helps avoid an overfilled face.