Sunken or hollow cheeks develop when the fat pads and bone that support the mid-face lose volume, most often because of ageing, significant weight loss, genetics, smoking, sun damage or dental changes. Mild hollowing can be softened with dermal filler, while fat grafting or a facelift may suit people whose hollowing comes with sagging skin.
What sits beneath the cheek
The cheek is built in layers. At the deepest level is the cheekbone and upper jaw. Over this lie several separate fat compartments, the muscles of facial expression and, finally, the skin. In youth, the fat compartments are full and sit high over the cheekbone, creating a smooth curve from the lower eyelid down to the jaw, sometimes described as the ‘ogee curve’. When these compartments shrink or slip, a hollow appears beneath the cheekbone and the face can look drawn, gaunt or tired, even when you feel well.
Common causes of hollow cheeks
- Ageing: the deep fat pads gradually deflate and the bone of the mid-face slowly remodels, reducing support.
- Weight loss: losing a substantial amount of weight, whether through diet, exercise, surgery or weight-loss medication, reduces facial fat as well as body fat.
- Genetics: some people naturally have prominent cheekbones with a hollow beneath, even in their twenties.
- Endurance exercise: very low body fat in long-distance runners and cyclists can show first in the face.
- Smoking and sun exposure: both damage collagen and elastin, thinning the skin that covers the cheek.
- Dental changes: tooth loss or dentures can reduce the support behind the lower cheek.
Often several of these factors combine, which is why two people of the same age can look very different.
When hollow cheeks need a medical check
Most cheek hollowing develops slowly and is harmless. See your GP if your face has become noticeably thinner without trying to lose weight, particularly if you also have tiredness, night sweats, loss of appetite or a change in bowel habit, as unexplained weight loss should always be investigated. Hollowing on one side only, or with pain, numbness or a lump, also warrants assessment before any cosmetic treatment is considered.
Non-surgical options
Hyaluronic acid dermal filler placed over and just below the cheekbone can restore some lost volume and lift the mid-face slightly. A skilled injector aims to rebuild support gradually rather than simply filling the hollow, which can look heavy or ‘pillowy’. Results are temporary and usually need topping up. Risks include bruising, swelling, lumps, asymmetry and, rarely, blockage of a blood vessel, so treatment must be carried out by a medical practitioner with detailed knowledge of facial anatomy. Good skin care, sun protection and stopping smoking help protect skin quality whatever else you choose.
Fat grafting
Fat grafting uses your own fat, harvested by gentle liposuction from the abdomen or thighs, purified and injected in small amounts into the cheek. Not all transferred fat survives, so the surgeon may slightly overcorrect or plan a second session. The fat that does establish a blood supply can be long-lasting and changes with your weight like any other fat. Swelling after fat grafting can take several weeks to settle. It is often combined with facelift surgery to address both volume and laxity in one operation.
When a facelift is more appropriate
In many people over fifty, hollowing beneath the cheekbone comes with descent of the cheek fat, deepening of the nose-to-mouth folds and jowling. Adding volume alone can make the face look heavier in these cases. A facelift or deep plane facelift repositions the deeper tissues and the cheek fat back towards where they once sat, and removes excess skin. Mr Nassab will assess whether your main problem is volume loss, sagging or both before recommending an approach. You can read more about the related topic of saggy cheeks.
Cost and next steps
Dermal filler and fat grafting are quoted at consultation, as the amount needed varies. A facelift costs from £14,500. A deep plane face and neck lift costs from £18,500 and a mini facelift from £8,000. The £150 consultation fee is separate and not included in any treatment price. Treatments are only provided to adults aged 18 and over.
Frequently Asked Questions
Can sunken cheeks be reversed naturally?
If hollowing is due to very low body fat, regaining a little weight may help. Age-related volume loss cannot be reversed naturally, though protecting the skin from sun and smoking slows further change.
Is filler or fat better for hollow cheeks?
Filler is quick and adjustable but temporary. Fat grafting is a surgical procedure with less predictable take, but surviving fat can be long-lasting. The choice depends on your anatomy and preferences.
Why do my cheeks look hollow after losing weight?
The face loses fat alongside the body, and the cheek fat pads are often among the first areas to show it.
Will a facelift fill hollow cheeks?
A facelift repositions tissue rather than adding volume, so it is often combined with fat grafting when hollowing is significant.
