Sunken Cheeks

The midface is where facial aging begins and it is almost never where patients think their problem is. Someone books about dark circles, or the lines running from nose to mouth, or a jawline that has gone soft, and all three trace back to the same place. Cheek volume supports the lower eyelid above it and holds up the tissue below it. When it deflates, the eye hollows, the fold deepens, and the jowl forms, from one cause.

Sam Assassa, MD was among the first physicians on the West Coast to introduce the CosmoFaceLift™ and has practiced non-surgical facial aesthetics in Los Angeles since 1995. He is board certified in Internal Medicine and has performed more than 25,000 aesthetic procedures.

What Causes the Midface to Deflate

Three layers lose volume, and they do it independently.

Fat. The cheek contains distinct fat compartments rather than one continuous layer. They shrink at different rates and they also descend, so the face loses fullness in the upper cheek while gaining it lower down.

Bone. The facial skeleton resorbs with age. The eye socket widens, the cheekbone loses projection, and the scaffolding beneath the soft tissue diminishes.

Muscle and skin. Both thin, so what remains has less support and less capacity to hold itself in place.

Two groups notice it earlier. Very lean and athletic people have less facial fat to begin with, so a proportional loss shows sooner. And anyone who has lost significant weight, including through medication, frequently sees midface deflation before any other facial change. That is covered on the Ozempic® face page.

What Deflated Cheeks Cause

This is why cheek treatment resolves complaints that had nothing obviously to do with cheeks.

Under eye hollows. The transition from lower lid to cheek becomes an abrupt step, and that step casts the shadow read as a dark circle.

Deeper nasolabial folds. The fold from nose to mouth deepens because the cheek that used to support the tissue above it has descended. Filling the fold directly treats a symptom.

Jowls. Cheek tissue that descends collects along the jawline. The jowl is midface tissue in a new location.

A flatter, more angular face. Losing the fullness across the midface squares the outline and makes the bony edges more prominent.

Flat Versus Fallen

Worth distinguishing, because they need different approaches.

Deflation means volume is gone. The face reads as flatter and more skeletal, and restoring volume is the answer.

Descent means the volume is still present but has moved lower. Adding more to a face that has descended enlarges it rather than lifting it.

Most patients have both. Which predominates governs how much is placed and where.

How Deflated Cheeks Are Treated

• Dermal filler, restoring volume at the cheekbone and midface immediately and reversibly, lasting one to two years. Covered on the cheek lift page.
• Fat transfer, using your own tissue where a large amount of volume has been lost or where durability matters.
• Vector lifting, placing structural filler at anchoring points where descent is the larger component.
• Nanofat, where skin quality has changed alongside the volume loss.

Have Your Midface Assessed in Beverly Hills

If your face has flattened, or your under eyes and folds have stopped responding to anything you put on them, the cheek is where that assessment starts. Dr. Assassa will evaluate your midface volume and tell you what restoring it would actually change. Request a consultation or schedule your appointment online.

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