How Can I Restore Lost Volume In My Cheeks After Weight Loss?

Q: Dr. Eppley, Five years ago, I lost 15-20 pounds rapidly (within three months) after starting crossfit. I loss facial volume in the cheeks, dark circles appeared, and my nasolabial folds became more pronounced. Since then, I have regained my weight, but my face has never returned to its previous state. I would like to know what could be done to improve it? I prefer a permanent solution with the least amount of risk possible. I would appreciate to have your opinions.

I have read on the subject online, but there are too many options and misleading information.

– Cheek Implants

– Fat transfers (results take three to six months to take effect/lack of predictability/lumps and bumps)

Microgranular fat grafting

– Dermal Fillers

Temporary (such as Restylane)

Semi-permanent (such as Sculptra)

Permanent (such as Bellafill)

– Lifting the Malar Fat Pad

– Thread Lift

– Deep face lift

– Mini facelift

– SMAS

– Transconjunctival Blepharoplasty

– Lower lid tightening

– Microneedling

I found you on Internet from a post of one of your patient (https://www.reddit.com/r/cosmeticsurgery/comments/qbjufp/jawline_and_cheek_implants_dr_barry_eppley/). Very impressive transformation.

I might be interested by cheek implants and jaw implant as well as blepharoplasty, but I’m not an expert about what is the best option for me. I would appreciate your opinion based on my photos.

A:Thank you for your inquiry and sending your pictures to which I can make the following comments:

Anytime you see many different ways to treat a common problem, and cheek volume loss/sagging is a common one, that speaks to the fact that no single method works for everyone and probably none of them are terrific at effectively improving the problem.
In the end your comprehensive list comes down to two basic approaches…lifting and volume expansion. As a general rule you can’t lift away a volume depletion problem that is magnified by a skeletal deficiency….which is what your overall issues are. So that reduces your list down considerably.
Injectable fillers are fine for a trial effect as they are at least reversible but their aesthetic effects are going to be limited/underwhelming.
Never approach your undereye/cheek volume expansion with fat grafting. Besides creating a balloon effect it has virtually no lifting benefit and is largely irreversible. It may have a minor role in supplementation to another treatment but not for a primary effect.
Infraorbital-malar implant augmentation seems best suited for you but not standard cheek implants.
Assume the nasolabial folds will not change as they are usually refractory to just about everything. This is often an area for fat injection grafting which is done more for its opportunity factor than for its proven sustained effects.

Dr. Barry Eppley

World-Renowned Plastic Surgeon