Priorities
Volume loss and flat cheeks
Flattened cheeks, hollow temples, and a midface that has lost volume with age.
Treatments from $650
The short version
Volume loss changes the face gradually. The cheeks flatten and sit lower, the temples become hollow, and the face can look tired even when you’re well rested, often without any obvious sagging.
It’s caused by facial fat pads shrinking and bone remodeling with age, and it’s something a skin-tightening device can’t correct.
Why it happens
Why faces lose volume
Volume loss is mostly about what sits under the skin. With age, the fat pads that shape your cheeks and temples shrink and slide a little lower, and the bone underneath slowly remodels, so the face loses the soft curves that made it look rested.
Fat pads shrink
The fat under your cheeks, temples and around the eyes thins with age, which can make the face look flatter or more tired.
Bone changes too
Gradual bone loss, often noticeable after 50, takes away some of the support the skin and fat rest on.
Skin loosens on top
As collagen and elastin thin, the skin over the area has less spring, so what volume is left sits lower.
Sources: Cleveland Clinic, aging skin
Your options
How we'd approach it
-
Step 1We'd start with
Dermal filler
From $650
About Dermal fillerIf the loss is in one or two places, usually the cheeks, a hyaluronic acid filler can put the volume back the same day. Our nurse practitioner will show you the change in a mirror before placing a second syringe, so you can decide together.
-
Step 2If you need a little more
Sculptra
From $900
About SculptraIf your whole midface has thinned, temples included, Sculptra helps build your own collagen over a few months. Results take longer and aren't visible on day one, but it's better suited to overall volume loss than treating one area at a time with filler.
Side by side
Your options side by side
Filler and Sculptra both restore volume, in different ways. Here's how they compare.
We'd start with
Dermal filler
From $650
- Best for
- Volume loss in one or two places, usually the cheeks
- Appointment
- 30 to 60 minutes, numbing included
- Downtime
- Swelling and possible bruising, settled by about two weeks
- First results
- Right away, under the swelling
- Sessions
- 1, with a check at two weeks
If you need a little more
Sculptra
From $900
- Best for
- Overall thinning across the midface and temples
- Appointment
- 30 to 45 minutes per session
- Downtime
- Swelling and bruising 1 to 7 days, plus 5 days of massage
- First results
- 4 to 6 weeks after the first session
- Sessions
- Typically 3, at least 3 weeks apart
PDO threads
From $1,000
- Best for
- Mild sagging that needs a little lift, not more volume
- Appointment
- 45 to 90 minutes with local anesthetic
- Downtime
- Sore for a few days, swelling and bruising up to a week
- First results
- A modest lift on the day, clear once swelling settles
- Sessions
- 1, repeated at about 12 months if you want it
Prices are starting prices from our menu. Your provider will confirm the plan and total cost at your consult. Individual results vary.
What to expect
What to expect after cheek filler
You'll see the volume right away, then a little swelling for a few days. The real shape shows at two weeks, when we check in with you.
Day 0
Immediate volume
Volume plus swelling. Lips may look fuller than planned while swollen.
Days 1 to 3
Swelling peaks
This is when a bruise shows if you’re going to get one.
Week 2
Two-week check
Lumps and firmness soften as the shape settles. We add a little more only if the plan called for it.
Months 6 to 18
Gradual fade
Volume fades gradually, lips first. Book a touch-up whenever you notice it.
Timeline for dermal filler, from our treatment page. Individual results vary.
Our reasoning
How we decide
We’ll ask you to hold a hand mirror and tilt your chin down. If your cheeks look fine from that angle but flat from the front, the cheek fat pad is the likely cause, and one or two syringes of dermal filler in the right spot usually restores it. Restylane Lyft and Restylane Contour are approved by the FDA for cheek and midface volume, per Restylane, and RHA 4 is approved for the cheeks as well. Hyaluronic acid filler typically lasts 6 to 18 months depending on product and area, and it can be dissolved if needed.
If your temples are hollow, your cheeks are flat, and the skin over them looks thin, we’ll talk with you about Sculptra. It’s poly-L-lactic acid, approved for cheek wrinkles and facial folds, given over two or three sessions. In its cheek trial, 70.7 percent of people were still responders at 12 months, per the FDA summary. Individual results vary.
Last, we’ll check whether the tissue has dropped, not just deflated. A jowl below the jaw is descent, and past a certain point we’d suggest PDO threads or a surgeon rather than adding product.
Your questions, answered
How many syringes of cheek filler do I need?
Most first visits use one syringe per side or less. We prefer to under-fill slightly and check in at two weeks. A face that has lost a lot of volume can need more over a few visits, and that's usually when we'll talk about Sculptra.
Sculptra or filler, which is better?
They each do a different job. Filler gives an immediate, precise, reversible result in one area. Sculptra gives a gradual, diffuse result that builds over three to six months and can last up to two years for some people. If you want an immediate change, filler is the better choice. For volume loss across the whole face, Sculptra is likely the better fit.
Can I drive home after cheek filler?
Yes. You may have mild swelling or a bruise, but nothing that affects driving, and parking is free right outside Suite C. Skip the gym, alcohol, and saunas for a day or two.
Why does my face look tired even when I'm rested?
Often it's volume loss. As the fat pads in your cheeks and under your eyes shrink, the face loses the soft curves that catch the light, and shadows form instead. Restoring a little volume in the right place can make you look more rested without looking done.
At what age do cheeks start to lose volume?
It varies a lot, but many people notice it in their late 30s or 40s, and faster after big weight changes. Genetics and sun exposure play a part too. We'll look at where the change is coming from rather than your age.
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