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Sunken Cheeks – Causes & Treatments

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Sunken cheeks — the visible hollowing between the cheekbone and jawline that gives the lower face a flat or gaunt appearance — are one of the most consistent markers of facial ageing, and one of the most amenable to treatment. The right approach depends entirely on the cause: age-related volume loss responds to different interventions than genetic bone structure or weight-related hollowing.

This guide covers the actual causes of sunken cheeks, the treatments that genuinely work (surgical and non-surgical), who suits each approach, and the lifestyle factors that influence both the and the longevity of treatment results.

What causes sunken cheeks

Several distinct factors contribute, often in combination:

Age-related volume loss. The most common cause. The fat compartments of the mid-face progressively thin from the 30s onward — particularly the deep medial cheek fat and the superficial nasolabial fat. As these compartments deflate, the cheek loses its forward projection and the area beneath the cheekbone hollows.

Bone changes. The facial skeleton itself changes with age. The cheekbone (zygoma) can become less prominent through subtle resorption. The maxilla (upper jaw) reduces in height, retracting the mid-face. These bony changes contribute to the overall flattening of the cheek area.

Genetic predisposition. Some have naturally hollowed cheeks from a young age due to bone structure (less prominent zygomatic arch) or genetically lower fat density in the mid-face. This isn’t ageing — it’s underlying anatomy.

Weight loss. Significant weight loss reduces facial fat . For patients whose face was previously fuller, the post-weight-loss appearance can include pronounced cheek hollowing alongside other facial changes. This is common after substantial weight loss whether from diet, bariatric surgery, GLP-1 medications, or illness.

Sun damage and skin quality. Cumulative UV damage thins the skin and accelerates the descent of tissue. The hollowing appearance is partly a consequence of weakened skin support combined with volume loss beneath.

Smoking. Reduces blood supply to facial tissue and accelerates both fat and skin quality deterioration. Long-term smokers typically show more pronounced cheek hollowing for their age than non-smokers.

Medical conditions. Some conditions produce facial fat loss as a feature — HIV-associated lipoatrophy (historically), certain medications, severe illness. These require specialist medical alongside cosmetic consideration.

Excessive exercise or restrictive diet. Very lean body composition with low body fat percentage produces facial hollowing. The face is one of the last areas to retain fat — when overall body fat drops below a certain threshold, the cheeks lose volume.

The depends entirely on which factors are dominant in your particular case.

Dermal filler — the first-line non-surgical treatment

For most patients with sunken cheeks, using hyaluronic acid is the most effective non-surgical intervention. Filler placed at strategic anchor points along the cheekbone volume and forward projection, lifting the tissue and reducing the visible hollowing.

Where filler is placed:

The result: restoration of the youthful "ogee curve" — the gentle convexity that defines a healthy cheek — and softening of the visible hollow below. The change is immediate and develops further over 2 weeks as initial swelling resolves.

What to expect:

How long it lasts: months for most patients. Cheek filler typically outlasts filler in more mobile areas like the lips.

Cost: from £450 per syringe; typical treatment uses 1-3ml depending on the extent of hollowing.

For comprehensive refreshment combining cheek filler with other anchor points, see our service page. For the filler discussion, see our .

Facial fat transfer — the longer-lasting alternative

For patients wanting more substantial or longer-lasting volume restoration, uses the patient’s own fat (harvested by liposuction from the abdomen, thighs, or flanks) and places it into the hollow areas of the face after careful .

Advantages of fat transfer:

Considerations:

What to expect:

Cheek implants — the surgical structural option

For patients with volume loss where filler or fat would very large volumes, or for patients whose underlying bone structure is inadequately prominent of soft tissue, cheek implants provide permanent structural augmentation.

The procedure uses solid silicone implants placed through small intra-oral incisions, positioned over the cheekbone, and secured. The result is permanent enhancement of the underlying bony framework. Once placed and healed (typically 6-8 weeks), the implants don’t change with time.

Advantages: permanent, structural, doesn’t require maintenance.

Disadvantages: surgical procedure with associated risks (infection, malposition, palpability), permanent commitment, less natural feel than fat transfer.

Cheek implants are appropriate for a specific subset of patients with genuine bony structural deficiency, not for most patients with age-related cheek hollowing. Most patients are better served by filler or fat .

Mid-face lift

For patients whose cheek hollowing is accompanied by descent of the mid-face — the cheek tissue has both lost volume and slipped — a or mid-face lifting procedure may be appropriate.

This isn’t a treatment for sunken cheeks alone — it’s a procedure for combined volume loss and tissue descent. The technique repositions descended cheek tissue back to its original anatomical position, restoring fullness through repositioning rather than volume addition.

Mid-face lift is appropriate for patients with:

For the broader surgical options, see our guides on , , and .

For the head-to-head comparison of when filler vs surgery is appropriate, see our guide on .

Biostimulators for skin quality alongside volume

For patients whose sunken cheek appearance is accompanied by poor skin quality (crepiness, thin skin, surface ageing), bioremodelling treatments improve dermal quality alongside whatever volume restoration is performed:

— bioremodels skin through high-concentration HA injection at specific anchor points. Improves elasticity, hydration, and overall skin quality. See our .

— DNA-fraction injections that stimulate fibroblast activity and improve dermal quality through different biological mechanisms.

(Redensity 1 and others) — combined HA, amino acid, antioxidant, and mineral injections for surface skin improvement.

These don’t address volume directly but improve the surrounding skin quality, making the volume restoration look more natural.

Energy-based skin tightening

For patients whose cheek appearance is affected by skin laxity in addition to volume loss, energy-based treatments can tighten and improve the skin alongside other treatments:

— dual-wavelength laser including intra-oral pass. Tightens skin and improves quality.

— radiofrequency microneedling for deeper skin tightening.

— radiofrequency-assisted lipolysis for more substantial skin tightening with about a week of recovery.

These can be combined with filler or fat transfer for comprehensive non-surgical mid-face — see our for the broader treatment philosophy.

Who suits which approach?

The right treatment depends on the dominant cause:

Mild to moderate age-related volume loss: cheek filler, often combined with skin treatments.

Substantial volume loss in younger patients: fat transfer for longer-lasting restoration.

Post-weight-loss hollowing: filler or fat transfer depending on extent; cheek implants in cases.

Genetic predisposition with otherwise normal facial proportions: filler or cheek depending on the patient’s preferences for reversibility vs. permanence.

Combined volume loss and mid-face descent: surgical mid-face lift, possibly combined with fat transfer.

Volume loss with skin quality concerns: combined plan including filler/fat transfer + biostimulators + treatments.

A consultation establishes which combination your specific and goals.

Lifestyle factors that genuinely matter

For all patients with sunken cheeks, several lifestyle factors significantly affect both appearance and treatment longevity:

Body fat percentage. Very lean body produces facial hollowing. For patients whose cheek hollowing is partly weight-related, modest weight gain (or moving away from extreme leanness) can produce meaningful .

Stable weight. Avoiding weight cycling — loss and gain — protects facial fat from chronic atrophy. The face is one of the most areas of the body.

Sun protection. Daily SPF 30+ on the face protects against the UV damage that accelerates both volume loss and skin quality changes. The single highest-impact preventive measure.

Stop smoking. Smoking accelerates facial volume loss dramatically. Stopping doesn’t reverse existing damage but substantially slows further deterioration.

Limit alcohol. Chronic high alcohol intake depletes facial fat and damages skin quality. Moderation helps.

Sleep position. Sleeping on one side can produce subtle facial asymmetry over decades, though this is minor compared to other factors.

Stress . Chronic stress accelerates aging through multiple mechanisms. Genuine stress management produces real long-term benefits.

These habits don’t eliminate sunken cheeks but slow further loss and extend the duration of treatment results.

Cost summary

, including 0% APR, are available across all treatments.

Common questions

For weight-related hollowing, modest weight gain can restore some volume. For age-related or hollowing, no lifestyle intervention restores the underlying volume — only does.

Not when conservatively dosed. The aim is restoration of natural projection, not maximalist . Overfilled cheeks typically result from years of accumulating filler without dissolving — the cumulative effect rather than any single treatment.

Immediate visible improvement. Final result at 2 weeks once swelling resolves.

HA cheek filler can be dissolved with within hours. This is one of the safety advantages of HA filler over permanent alternatives.

The donor site (liposuction area) is more than the recipient site for several days. Both heal predictably with appropriate aftercare.

Limited evidence. The muscles in question aren’t easily strengthened by deliberate exercise, and even strengthened muscles wouldn’t significantly restore the missing volume. Facial exercises are a low-impact lifestyle intervention without significant downside, but they’re not a treatment for sunken cheeks.

Topical products work on the outer layers of skin and can improve hydration and surface appearance. They don’t reach the subcutaneous fat where ageing changes actually occur. Topical skincare is a useful adjunct, not a treatment.

Yes — most combinations work well with appropriate sequencing. A typical combined plan might include cheek filler + Profhilo + Morpheus8 over 2-3 months, with maintenance approximately annually.

Yes — filler or fat transfer can effectively restore volume lost through weight loss. The treatment effect doesn’t depend on the original cause. However, future weight matters — significant subsequent weight loss can affect the result.

Treatment is appropriate whenever the appearance bothers you and your anatomy is . There’s no specific age threshold. Patients in their 30s, 40s, 50s, and beyond all have cheek performed . The technique and product choice are tailored to your specific and goals.

Centre for Surgery · CQC-regulated · GMC specialist-registered surgeons · · · ·

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Centre for Surgery is a CQC-regulated private on London’s Baker Street, delivering and cosmetic surgery through GMC-registered specialist surgeons. Our expertise spans facial procedures including and , , for men, and body contouring procedures such as and . Patient safety, surgical excellence and natural-looking results sit at the heart of everything we do.

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