Q: Dr. Eppley, I am a 25 year old man and I want to fix the sunken look I have in my midface area. Below my cheeks it is very hollow. In addition, there are indented lines which I call railroad track lines in my midface? I have read about filler injections but I know they are only temporary and may leave a plump, round shape which I don’t want. I would like to have a more narrow/angular look. Do you think cheek implants will work?
A: Hollowing below the cheeks, known as submalar hollowing, is the result of the cheek soft tissue not being supported by bone. Without a large buccal fat pad or thick subcutaneous fat being there, this area will become a concavity and not a convexity. Injectable fillers can certainly be used as a temporary augmentation method but I would agree that it lacks the ability to create sharp definition. Cheek implants are the only other options and they do provide a permanent change. But there are numerous types of cheek implants and it would be very important to get the right implant shape to achieve the desired result. Submalar cheek implants would theoretically be the best choice but they do add some cheek width and lateral fullness.. It may be better to use a combined malar and submalar implant, known as a malar shell, and modify the submalar edge to create medial augmentation of the submalar hollow but not lateral fullness.
Dr. Barry Eppley