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Sunken Cheeks (Cheeks That Have Lost Volume) | A Doctor Explains the Causes, Treatment Options, and Costs
Hello, I am a doctor at Smart Skin Clinic, an aesthetic dermatology clinic.
"Lately my cheeks look a little sunken and gaunt…"
"My weight hasn't changed, so why does only my face look thinner? It somehow makes me feel my age…"
"Why are my cheeks getting hollow? Is there a way to fix it with home care?"
When the face loses its roundness and the underlying bone structure becomes more prominent, some people may feel exactly this way.
As we age, the face loses its plump volume as fat decreases and the skin's firmness and elasticity decline. This can make the face look bony and cause the cheeks to become hollow.
The root cause of cheek hollowing is the changes the body undergoes with age, but various other factors also interact and contribute to it.
In this article,
- Why are my cheeks getting hollow?
- Is there any way to fix hollow cheeks?
- I want a plump, youthful face like I used to have.
To help answer questions and concerns like these, our aesthetic dermatology clinic offers a clear, easy-to-understand explanation.
If you are troubled by hollow cheeks, we hope you'll find this helpful.
(If you'd like to skip ahead to the specific treatments, you can jump directly there from the table of contents.)
Group Chief Director, Smart Skin Clinic Group
Ishii Kota
Career
Graduated from Juntendo University School of Medicine
Worked at Tokyo Women's Medical University Hospital and affiliated facilities
Worked at a major aesthetic clinic in Tokyo
Affiliations / Qualifications
Board-certified specialist, Japan Surgical Society
Board-certified specialist, Japanese Society of Anti-Aging Medicine
What Is Cheek Hollowing?
Cheek hollowing refers to a loss of volume in the cheeks, which makes the cheekbones and facial contours more prominent.
Even if your cheeks aren't sunken enough to have actual dimples or shadows, if your face as a whole looks thinner or gives a tired or gaunt impression, it may be worth considering that you have some degree of cheek hollowing.
Hollow cheeks not only make you look thin and bony, they also make the lines around the mouth and shadows on the face more noticeable, which can make you look older than you really are.
The main cause of cheek hollowing is the changes the body undergoes with age, but lifestyle also plays a major role. First, let's take a closer look at the causes.
Causes of Hollow Cheeks
Causes of hollow cheeks include the following.
- Loss of facial fat
- Skin aging and sagging
- Muscle weakening
- Skeletal changes
We will explain each of them.
(1) Loss of fat
Facial volume is created mainly by subcutaneous fat. As a result, when facial fat decreases, the cheeks appear hollow.
Causes of facial fat loss include aging, excessive dieting, and lifestyle habits.
To begin with, as we age, the fat in the deep layers of the face gradually atrophies as a natural change of the body. When excessive dieting, an unbalanced diet, and heavy drinking or smoking are added on top of this, fat loss accelerates.
(2) Skin aging and sagging
The skin's elasticity and firmness are maintained by fibrous proteins such as collagen and elastin in the dermis.
However, as these proteins decrease or weaken due to aging and UV exposure, the skin becomes thinner and gradually sags. What once sat in the cheek area then droops downward under the pull of gravity, making the cheeks appear hollow.
(3) Muscle weakening
The facial muscles that create our expressions lie even deeper, beneath the skin and fat, and draw the skin and fat inward.
As the muscles weaken, their pulling power diminishes and they gradually stretch and slacken. This causes the cheeks to sag and become hollow.
Muscle mass naturally declines with age, but other factors can play a part too, such as muscle atrophy from lack of use, or posture and habits that make just one cheek more prone to hollowing.
(4) Skeletal changes
As bones age, bone density decreases and the skeleton atrophies. In simple terms, the bones grow thinner and the facial bones become smaller overall.
As the underlying bone shrinks, the skin, fat, and muscle resting on top of it are left with excess and begin to droop downward under gravity.
Some causes of hollow cheeks can be improved through lifestyle habits and care you can do at home. A well-balanced diet, moderate exercise, adequate sleep, stress management, quitting smoking, and UV protection are all important for preventing and improving hollow cheeks.
Let's take a look at the home care and lifestyle habits you can practice at home.
Home Care to Improve Hollow Cheeks
Home care and lifestyle practices you can do at home to improve hollow cheeks include the following.
- Reviewing your dietary habits
- UV protection
- Stress management
- Moderate exercise
Let us explain each of them.
(1) Reviewing your dietary habits
A nutritionally unbalanced diet accelerates skin aging.
Protein, vitamins, and minerals are nutrients essential to producing collagen, elastin, and other components that support the skin's elasticity and firmness.
- Excessive dieting
- A carbohydrate-centered diet
- Frequent consumption of fast food and instant meals
Take a moment to reflect on whether your diet looks like this.
(2) UV protection
UV rays reach deep into the skin, and when they break down collagen and elastin, they age the skin. Proper UV protection helps keep the skin supple and can prevent sagging and hollow cheeks.
Along with using sunscreen, hats, and parasols to protect against UV rays, it's even better to eat antioxidant-rich foods to help reduce the skin damage caused by UV exposure.
(3) Stress management
Chronic stress disrupts hormonal balance and accelerates skin aging and fat loss. Stress can also trigger a vicious cycle of smoking, excessive alcohol consumption, and lack of sleep, which age the skin further, so stress management is important.
Try to lead a life that doesn't let stress build up, using stress-relief methods that suit you.
(4) Moderate exercise
Moderate exercise promotes blood circulation and helps maintain and strengthen the muscles, so it can help improve hollow cheeks.
Examples include facial exercises, full-body strength training and aerobic exercise, and stretching and massage.
However, there are a few points to keep in mind.
Overly strenuous exercise can lead to loss of muscle and fat.
Also, stretching and massaging the cheeks the wrong way can actually contribute to sagging.
Aim for a moderate amount of exercise and proper massage technique.
Overview of the Three Effective Treatments for Cheek Hollowing | Fat Grafting, Hyaluronic Acid Injection, and Skin-Nurturing Formulations
Effective approaches to improving hollow cheeks include:
- Directly filling in the lost cheek volume
- Restoring thickness, firmness, and elasticity to skin that has thinned and lost its firmness and elasticity, plumping up the skin itself
There are these two approaches.
The former includes fat grafting and hyaluronic acid injection, both proven treatments performed for many years.
The latter includes "skin-nurturing formulations," which have recently become a hot topic on social media.
A skin-nurturing formulation is a preparation that, when injected, can improve the quality of the skin around the injection site.
The specific skin-improving action varies with each formulation, buta common effect of all of them is that they work on the tissue of the dermis to improve the skin's texture, firmness, and elasticity.
It's easier to understand if you have a rough grasp of how each treatment differs, so please refer to this table. Details are described below.
| fat injection | Hyaluronic acid injection | Skin-nurturing formulations | |
|---|---|---|---|
| Volumizing effect | High Large volume increase possible | Medium to high Injection volume can be adjusted | Low Volumizing effect is limited |
| Ease of treatment Downtime | Not easy Surgery is required, as liposuction is needed Long downtime | Easy Can be performed with injection alone Short downtime | Easy Can be performed with injection alone Short downtime |
| Cost | High Involves the surgical cost of liposuction and grafting | Moderate Lower one-time cost than fat grafting, but requires ongoing treatment | Medium to high Depends on the formulation and number of treatments |
| Time until effect appears (Immediacy) | Relatively fast-acting However, it takes time for the swelling to subside | Highly fast-acting Effects felt right after treatment | Effects appear gradually Effects felt within a few days to a few weeks |
| Duration of effect (Longevity) | Long Fat that takes hold lasts semi-permanently | Moderate Lasts about 6 months to 1 year | Moderate Effects last several months |
| Naturalness of the result | Natural, but with a risk of asymmetry Results vary depending on the retention rate | Natural A natural result when the right amount is placed in the right area | Very natural Improved skin quality and a natural rejuvenating effect |
| Importance of the practitioner's skill | Very high Fat harvesting and injection technique determine the results | High Requires injection at the appropriate site and depth | Moderate Basic injection technique required |
| Skin-improving effect | Somewhat present Stem cells in the fat may improve skin quality | Limited Mainly aimed at adding volume | High Strong skin-improving effects, including better hydration and firmness |
| Other features | – Fat retention rates vary from person to person - Surgical risk involved | – Can be dissolved if needed - Risk of vascular injection | - Generally, multiple treatments are recommended |
Effective Treatment for Cheek Hollowing | (1) Fat Grafting
What is fat grafting?
In fat grafting, excess fat is first harvested from your own body (the abdomen, hips, thighs, and so on). After removing impurities, the collected fat is injected directly into the areas where volume has been lost, restoring fullness.
Because it uses your own fat, natural-looking results can be expected, and the risk of an allergic reaction is considered low.
Advantages and Disadvantages of Fat Grafting
- Natural finish
- Long-lasting effects
- Low risk of allergy
- Allows for targeted slimming
- Skin-improving effects can also be expected
An advantage of fat grafting is that, because it uses your own fat, it feels and looks natural, with almost no concern about rejection or allergy.
In addition, once the injected fat takes hold, its effect lasts semi-permanently.
Since liposuction is performed together with the fat grafting, targeted slimming (improving the body line) is also possible.
Because fat cells contain stem cells, the stem cells may also help improve the quality of the skin at the injection site.
- Fat retention rates vary from person to person
- Long downtime
- Risks associated with surgery
- Risk of asymmetry
- High cost
A disadvantage of fat grafting is that the procedure is a surgery performed under anesthesia.
This means it carries risks such as complications from anesthesia, postoperative infection and bleeding, and intravascular embolism (fat embolism: a dangerous condition in which fat enters the blood vessels and obstructs blood flow).
It also involves two steps: harvesting (collecting) and injecting the fat. In other words, because the body is stressed in two places, the downtime is longer and the cost is higher.
The retention rate of the injected fat varies from person to person, and even in the same individual, retention rates can differ between the left and right sides.
With fat grafting, the practitioner's skill and postoperative care are extremely important.Because the practitioner's skill greatly affects the results, it is important to choose a doctor you can trust.
Who fat grafting is recommended for
- People who want long-lasting effects
- People who want to use their own fat (those from whom enough fat can be harvested)
- People who can allow enough time for downtime
- People who value cost-effectiveness
When fat grafting takes hold properly, long-lasting effects can be expected. Because harvesting fat is a prerequisite, it can be difficult to perform on very slim people, but it is a recommended option for those who also want targeted slimming.
Since the surgeon's skill greatly influences the results, it may be worth considering fat grafting if you choose a doctor you trust and, after a thorough consultation, feel comfortable with the risks and disadvantages.
Effective Treatment for Cheek Hollowing | (2) Hyaluronic Acid Injection
What is hyaluronic acid injection?
Hyaluronic acid injection is a treatment in which a medical-grade hyaluronic acid preparation is injected into the hollow areas of the cheeks to restore volume.
Because it simply involves injecting the product with a syringe into the areas where you want to add volume, it is considered a relatively simple treatment.
It is a popular treatment injected into various areas of the face, including not only the cheeks but also the lips, forehead, and temples.
Advantages and Disadvantages of Hyaluronic Acid Injection
- Fast-acting
- Convenience
- Natural finish
- Easy to adjust
- Low risk of allergy
The advantages of hyaluronic acid injection lie in how quickly it works and how convenient it is.
You can feel the effect right after the injection, and the procedure takes only about 30 minutes. There is almost no downtime, and even on the day of treatment it doesn't significantly disrupt daily life.
Additional injections or fine adjustments can be made as needed, and if too much is injected, it can be removed with a dissolving agent.
- Duration of effect
- Side effects and risks
- Individual variation
A disadvantage of hyaluronic acid injection is that its effect lasts only about 6 months to 1 year.
Although there is individual variation, the injected hyaluronic acid is slowly absorbed.
The cheeks in particular are frequently in motion, so it is thought to be absorbed at a faster rate.
To maintain the effect, periodic injections are needed.
In addition, injecting too much hyaluronic acid can create an unnatural, overly voluminous look sometimes called a "filler face."
Also, if the hyaluronic acid is not distributed evenly, lumps or an uneven skin surface may result.
To achieve a natural result, the doctor's design skill is important.
Finally,the most important risk to note isthe risk of intravascular injectionare available.Intravascular injection may not occur frequently,but if it does, it can cause impaired blood flow and skin necrosis,which is whyit is essential to choose an experienced and trustworthy doctor.
Who hyaluronic acid injection is recommended for
- People who want immediate results
- People who want a simple treatment
- People who don't have excess body fat
- People who want to keep costs down
Hyaluronic acid injection is an easy-to-receive treatment that adds volume you can feel right after the procedure, with short treatment time and downtime and minimal pain.
The effect is temporary and requires periodic injections to maintain, but it is recommended for slim people who can't afford the cost of fat grafting and don't have fat that can be harvested.
That said, it requires the practitioner's design skill and the technical ability to avoid causing complications, so it's important to choose a doctor you can trust.
Effective Treatment for Cheek Hollowing | (3) Skin-Nurturing Formulations
What is a skin-nurturing formulation?
A skin-nurturing formulation is an aesthetic treatment in which the injected preparation promotes the production of collagen and elastin inside the skin, aiming to restore the skin's firmness and elasticity.
It focuses on nurturing the skin itself, and by enhancing the skin's firmness from within, it helps plump up the hollow areas of the cheeks.
The skin-nurturing formulation itself doesn't directly replenish volume, but it may add volume through collagen production.
There are many different types of skin-nurturing formulations. Among them, those considered effective for cheek hollowing include Profhilo, Lenisna, and Gouri injections.
The fundamental action of skin-nurturing formulations is shared, but the main ingredients of each differ, so every formulation has its own characteristics.
If you'd like to learn more about Profhilo, Lenisna, and Gouri injections, please see here.
Advantages and Disadvantages of Skin-Nurturing Formulations
- Natural rejuvenating effect
- Short downtime
- Safety
- Improvement of skin quality
An advantage of skin-nurturing formulations is that the people around you won't be able to tell you've "had something done."
Since skin-nurturing formulations are a treatment that nurtures the skin, a sudden increase in volume shouldn't be expected. But looked at another way,they gradually improve skin quality for natural anti-aging care.For those who have multiple concerns beyond cheek hollowing, such as wrinkles, sagging, and dullness, a single treatment may offer improvement.
The ingredients used in these formulations are often highly biocompatible, so allergic reactions are considered less likely.
In addition, because it is an injection-based treatment, downtime is short and it is easy to receive.
- There are limits when it comes to deep cheek hollowing
- Ongoing treatment is needed to maintain the effect
- Individual variation
A disadvantage of skin-nurturing formulations is that they are not well suited to deep cheek hollowing.
Some skin-nurturing formulations can add volume immediately, but the basic concept is best understood as nurturing and plumping up skin that has thinned and lost its firmness.
Also, once the injected formulation is absorbed, its effect fades.
How the effect appears and how long it lasts vary from person to person, and regular treatments are needed to maintain it (the interval between treatments depends on the formulation).
Who skin-nurturing formulations are recommended for
- People with mild to moderate cheek hollowing
- People seeking a natural result
- People who want to avoid downtime
Skin-nurturing formulations arerecommended for those with mild to moderate cheek hollowing who want to improve their skin's texture and firmness and restore a natural youthfulness.
They are easy to start, with little downtime and a low risk of allergy or side effects.
If your cheek hollowing isn't too severe, it may be a good idea to start with a skin-nurturing formulation as your first treatment and then consider other options as you monitor your progress.
Why Radiofrequency Treatment and Thread Lifts Aren't Included Among the Effective Treatments
We listed fat grafting, hyaluronic acid injection, and skin-nurturing formulations as the three effective treatments for improving cheek hollowing.
If you search for something like "improving cheek hollowing," you may have seen treatments such as radiofrequency treatment (HIFU) and thread lifts listed as candidates for effective treatments in addition to these three.
We'd like to explain why radiofrequency treatment and thread lifts are not included among the effective treatment candidates in this article.
To get straight to the point, it's because we consider radiofrequency treatment and thread lifts to be treatments used for sagging, and unlikely to serve as a fundamental treatment for improving cheek hollowing.
First, let us briefly explain each treatment: radiofrequency treatment and the thread lift.
Radiofrequency treatment delivers high-frequency energy to the skin, and this energy heats the subcutaneous tissue to tighten sagging skin.
It works on the same principle as raw meat shrinking when you cook it over heat.
A thread lift is a treatment in which special medical-grade dissolvable threads are inserted under the skin to physically lift it and improve sagging.
The reason radiofrequency treatment and thread lifts come up as candidates for improving cheek hollowing is that these treatments stimulate and increase the collagen in the dermis.
However, this effect is thought to be limited, not strong enough to be expected to improve cheek hollowing.
In addition, tightening the skin can conversely accentuate the lack of volume in the cheeks and heighten the hollow impression.
For these reasons, this article excludes radiofrequency treatment and thread lifts from the effective treatments.
Why Smart Skin Clinic Recommends Skin-Nurturing Formulations
So far, in "A Thorough Guide to Cheek Hollowing," we've explained the causes of hollow cheeks, home methods for improving them, and effective aesthetic treatments.
The original questions,
"Is there any way to fix hollow cheeks?"
"I want to know how to fix hollow cheeks,"
if we at the clinic were to answer them, our response would be:
"Skin-nurturing formulations are one effective option, too."
The reasons, as we mentioned in the article, are:
- It's difficult to improve hollow cheeks with home care alone
- Fat grafting and hyaluronic acid injection carry risks and require finding a doctor you can trust
- Skin-nurturing formulations are relatively low in cost
- And there are changes you can feel from a skin-nurturing formulation alone.
Smart Skin Clinic also offers free consultations.
Even if you're wondering, "What about my case?" or "I'd like to hear a bit more detail," you're very welcome.
If you're troubled by hollow cheeks, please feel free to reach out to us.
Physician Who Supervised This Page
Smart Skin Clinic, Chief Medical Director / Physician
Kota Ishii
We oversee treatment policies across the entire group, tailored to the skin condition of each individual patient. The content on this page has been reviewed and approved in line with our clinic's treatment policies.
Interview with Director Kota Ishii
Kota Ishii, our Chief Medical Director, shares our clinic's approach to patient care.
Clinic List
Jimbocho Clinic
〒101-0054
3-16-1 Kanda Nishiki-cho, Chiyoda-ku, Tokyo, EX Kanda Nishiki-cho Building 8F (general reception) / 7F
Hours: Mon–Fri 11:00–20:00 / Sat & Sun 10:00–19:00
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〒221-0835
TS Plaza Building 2F, 2-23-2 Tsuruya-cho, Kanagawa-ku, Yokohama-shi, Kanagawa
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About the physician supervision of this site
This site is operated under the supervision of a Smart Skin Clinic supervising physician.
This page was produced in accordance with the Medical Advertising Guidelines Medical Advertising Guidelines revised and enforced in June 2018, under which we produce and provide this information.
- Scope of supervision: treatment descriptions, risks and side effects, price display
- Last supervision date: June 26, 2025