As we age we loose fat from several areas in our face. The pattern of fat loss varies from person to person, but most of us will have the most fat loss from our midface or cheeks. There are two things that determine the shape of our cheeks – our cheek bones and the overlying fat pad know as the malar fat pad. As we age the fat pad gets smaller and eventually to a lesser degree we also have some bone atrophy. We can see this process create several changes on the face. First, we see an elongation of the lower eyelid. If you look at a child or a teenager their lower eyelid is very short and their cheek is very full. As we age our lower eyelids get longer and in most people they get full and/or puffy. This is primary because of lost cheek fat. There are several ways to restore volume to the cheek. The most common is with dermal fillers, most of these are now hyaluronic acid derivatives. The advantage of these is that they are off the shelf can be done on the same day in the clinic. You can often go back to work with a little bruising being the most common complication. The disadvantages of fillers is that they come in small volumes and reabsorb over time. Getting these injections every few years can get expensive. Another option is injections with your own fat. We use liposuction to remove some of your own fat, carefully process it, and then inject it back into deflated areas. This procedure is not as “in-and-out” as fillers and a small amount of the new fat will not survive, but the fat that does “take” will add permanent volume. The final method of cheek augmentation is with permanent implants. We most commonly use silastic (a clear flexible plastic) cheek implants, but there are several different types available. There are many different shapes and sizes of implant that allow an experienced surgeon to achieve results that are as tailored the patient’s needs as any filler. Some implant styles will make a face look more masculine, others will make it softer and more feminine. If a special implant is needed in cases of trauma or to correct significant asymmetry we can use a CT scan to create a one-of-a-kind custom implant. Implants can provide a more powerful lift than can be achieved with either fat or filler. The implants sit against the underlying bone and if they are properly placed you won’t be able to feel them at all. Facial augmentation with implants is becoming more and more common, and it is one of the most frequently performed procedures in our practice. In addition to cheek implants we also commonly place chin implants, jaw implants, and temple implants. If you think you may be a candidate for one of these procedures feel free to call our office with more information.