Sunken Cheeks – Causes & Treatments

In this guide17 sections

1. Key points
2. What causes sunken cheeks
3. When sunken cheeks need medical assessment, not cosmetic treatment
4. Facial lipoatrophy: when cheek fat loss has a medical cause
5. Sunken cheeks after weight loss
6. Cheek filler for sunken cheeks
7. Facial fat transfer — the longer-lasting alternative
8. Cheek implants — the surgical structural option
9. Mid-face lift
10. Biostimulators for skin quality alongside volume
11. Energy-based skin tightening
12. Who suits which approach?
13. How to fix sunken cheeks naturally — what works and what doesn’t
14. Lifestyle factors that genuinely matter
15. Cost summary
16. Frequently asked questions about sunken cheeks
17. References

Sunken cheeks — the visible hollowing between the cheekbone and jawline that gives the lower face a flat or gaunt appearance — are one of the most consistent markers of facial ageing, and one of the most amenable to treatment. The right approach depends entirely on the cause: age-related volume loss responds to different interventions than genetic bone structure or weight-related hollowing.

Hollow cheeks are frequently confused with two different problems. They are not the same as saggy cheeks, where the issue is tissue descending rather than deflating — though the two commonly occur in the same face, and treating only one is the usual reason people are unhappy with a result. Nor are they the same as malar fat pad descent, where the cheek volume is still present but has slipped downward and needs repositioning rather than replacing.

This guide covers the actual causes of sunken cheeks, the treatments that genuinely work — from cheek filler through facial fat transfer to surgical options — who suits each approach, and the lifestyle factors that influence both the appearance and the longevity of treatment results. If you are weighing up injectables against surgery, our comparison of dermal fillers versus facelift surgery covers where the crossover point sits.

What causes sunken cheeks

Several distinct factors contribute, often in combination:

Age-related volume loss. The most common cause, and the reason age alone is a poor guide to what treatment you need. The fat compartments of the mid-face progressively thin from the 30s onward — particularly the deep medial cheek fat and the superficial nasolabial fat. As these compartments deflate, the cheek loses its forward projection and the area beneath the cheekbone hollows.

Bone changes. The facial skeleton itself changes with age. The cheekbone (zygoma) can become less prominent through subtle resorption. The maxilla (upper jaw) reduces in height, retracting the mid-face. These bony changes contribute to the overall flattening of the cheek area.

Genetic predisposition. Some patients have naturally hollowed cheeks from a young age due to bone structure (less prominent zygomatic arch) or genetically lower fat density in the mid-face. This isn’t ageing — it’s underlying anatomy, and it responds differently to treatment. Worth noting the opposite case too: some people actively seek this look and pursue buccal fat removal to achieve it. If you already have naturally hollow cheeks, buccal fat removal is the one procedure to avoid, because it deepens exactly the hollow you are trying to correct.

Weight loss. Significant weight loss reduces facial fat substantially. For patients whose face was previously fuller, the post-weight-loss appearance can include pronounced cheek hollowing alongside other facial changes. This is common after substantial weight loss whether from diet, bariatric surgery, GLP-1 medications, or illness.

Sun damage and skin quality. Cumulative UV damage thins the skin and accelerates the descent of underlying tissue. The hollowing appearance is partly a consequence of weakened skin support combined with volume loss beneath.

Smoking. Reduces blood supply to facial tissue and accelerates both fat atrophy and skin quality deterioration. Long-term smokers typically show more pronounced cheek hollowing for their age than non-smokers.

Medical conditions. Some conditions produce facial fat loss as a feature — HIV-associated lipoatrophy (historically), certain medications, severe illness. These require specialist medical assessment alongside cosmetic consideration.

Excessive exercise or restrictive diet. Very lean body composition with low body fat percentage produces facial hollowing. The face is one of the last areas to retain fat — when overall body fat drops below a certain threshold, the cheeks lose volume.

The treatment depends entirely on which factors are dominant in your particular case.

When sunken cheeks need medical assessment, not cosmetic treatment

Most facial hollowing is ordinary ageing or weight change. Some of it is not, and it is worth ruling that out before spending money on filler.

See your GP first if the hollowing:

• came on rapidly over weeks or a few months, rather than gradually over years
• is accompanied by weight loss you did not intend or cannot explain
• comes with persistent fatigue, night sweats, fever, or loss of appetite
• appears alongside difficulty swallowing, a persistent cough, or a lump anywhere
• affects one side of the face noticeably more than the other
• developed after starting a new medication

On the cancer question. A great many people search for whether sunken cheeks indicate cancer, so it deserves a straight answer. Facial hollowing is not a sign of cancer in itself. It can accompany significant unintentional weight loss, and unintentional weight loss is one of the symptoms that warrants investigation — but the hollow cheeks are a consequence of the weight change, not a diagnostic sign of anything specific. Many entirely benign things cause the same appearance: dieting, illness and recovery, thyroid disease, coeliac disease, diabetes, HIV-associated lipoatrophy, long-term steroid use, smoking, and simply ageing.

What matters is not the cheeks on their own but the pattern around them. Gradual hollowing in your forties with stable weight and no other symptoms is ageing. Rapid hollowing with unexplained weight loss and fatigue is a reason to see a doctor this week, not a reason to book a cosmetic consultation.

We routinely decline to treat patients whose hollowing has not been explained. If you come to us with rapid unexplained volume loss, we will tell you to see your GP first — filling a face while an underlying cause goes uninvestigated helps nobody.

Facial lipoatrophy: when cheek fat loss has a medical cause

Facial lipoatrophy is the medical term for loss of the fat that sits beneath the skin of the face. The cheeks hold much of the face’s soft-tissue volume, so this is usually where it shows first: flattening below the cheekbone, a sharper bony outline and, in more advanced cases, visible muscle contours. It differs from ordinary ageing in its speed and pattern, and the cause decides the plan.

• HIV treatment. Older thymidine-analogue antiretroviral drugs were closely linked to facial fat loss. Laboratory research published in Antimicrobial Agents and Chemotherapy in 2013 ↗ showed these drugs disrupt how fat cells clear damaged mitochondria and mature^[1].
• Steroid injections. Repeated corticosteroid injections into the same spot can leave a localised dent. In a 2022 retrospective study of 24 patients with injection-related atrophy ↗, two-thirds improved with treatment^[2].
• Autoimmune and inflammatory disease. Lupus profundus, localised scleroderma (morphoea) and Parry–Romberg syndrome (progressive hemifacial atrophy) can remove fat, and sometimes muscle and bone, usually on one side of the face. These are managed by a dermatologist or rheumatologist first, with reconstruction planned once the disease is stable; in a 2026 series of 22 Parry–Romberg patients followed for an average of 16 years ↗, 20 went on to reconstructive surgery^[3].
• Rapid weight loss. Covered in the next section.

Once the underlying cause is under control, volume replacement works well. In a 2014 double-blind randomised trial of 49 patients published in Plastic and Reconstructive Surgery ↗, facial fat grafting produced a CT-measured gain in facial volume that was still present at 12 months, with no major complications^[4]. Hyaluronic acid filler is the reversible alternative, and a sensible first step while a condition is still settling.

Sunken cheeks after weight loss

Weight loss is the most common non-age cause of hollow cheeks, and it has become considerably more common since GLP-1 medications such as semaglutide came into widespread use. The mechanism is simple: the mid-face fat compartments that give the cheek its fullness lose volume along with fat everywhere else, and the skin and deeper tissue are left draped over a smaller structure.

The effect is more pronounced when the loss is rapid, when it is substantial, and when it happens over the age of about forty — because older skin has less elasticity to take up the slack.

How much volume is actually needed is worth knowing before you start. In a series of face-lift patients who had undergone massive weight loss, 86% had documented volume loss in the mid-face and nasolabial regions, and the surgeons used almost twice as much fat for augmentation as in non-weight-loss patients — 22ml against 12ml (Plastic and Reconstructive Surgery 2015 ↗)^[5]. Two practical conclusions follow. Lifting alone will not correct a weight-loss face, because the problem is deflation rather than descent. And if you are quoted for a volume procedure based on what a typical ageing face needs, expect the real requirement to be higher.

Wait until your weight is stable. We ask for three to six months of stable weight before treating. Continuing to lose afterwards will undo the result; regaining will distort it. If you are still titrating a GLP-1 dose, that is a reason to wait rather than proceed. Our guide to face and neck lift surgery after weight loss covers the fuller picture.

Cheek filler for sunken cheeks

For most patients with sunken cheeks, cheek filler using hyaluronic acid is the most effective non-surgical intervention. Filler placed at strategic anchor points along the cheekbone restores volume and forward projection, lifting the surrounding tissue and reducing the visible hollowing.

Where filler is placed:

• The lateral cheekbone (highest point of the zygomatic prominence)
• The malar fat pad area (mid-cheek)
• The submalar region (just below the cheekbone, where the actual hollowing sits)
• The anterior cheek toward the nose, where appropriate

The result: restoration of the youthful “ogee curve” — the gentle convexity that defines a healthy cheek — and softening of the visible hollow below. The change is immediate and develops further over 2 weeks as initial swelling resolves.

What to expect:

• Treatment takes 30-60 minutes
• Topical anaesthetic applied for 15-20 minutes before treatment
• Cannula or fine needle technique depending on the area
• Mild swelling and possible small bruising for 3-5 days
• Final result visible at 2 weeks

How long it lasts: 12-18 months for most patients. Cheek filler typically outlasts filler in more mobile areas like the lips.

Cost: see our Skin & Aesthetics price list; typical treatment uses 1-3ml depending on the extent of hollowing.

For comprehensive non-surgical refreshment combining cheek filler with other anchor points, see our liquid facelift (8-point lift) service page. For the broader filler discussion, see our dermal fillers FAQ.

Facial fat transfer — the longer-lasting alternative

For patients wanting more substantial or longer-lasting volume restoration, facial fat transfer uses the patient’s own fat (harvested by liposuction from the abdomen, thighs, or flanks) and places it into the hollow areas of the face after careful processing.

Advantages of fat transfer:

• Permanent for the surviving fat (typically 50-70% of what’s placed)
• Uses your own tissue — no foreign body considerations
• Particularly suited to substantial volume loss
• Improves skin quality at the recipient site through stem cells and growth factors in the transferred tissue
• Can be combined with other surgical procedures (facelift, lip lift) in the same operative setting

Considerations:

• More involved procedure — typically performed under local anaesthesia with sedation
• More substantial recovery (1-2 weeks of significant swelling)
• Partial absorption of placed fat is normal — some patients need a second session
• Higher upfront cost than filler
• Weight changes affect the transferred fat (gaining weight increases volume; losing weight decreases it)

What to expect:

• Procedure takes 90-180 minutes depending on number of areas treated
• Liposuction donor site and recipient cheek both have swelling for 1-2 weeks
• Final result develops over 3 months as surviving fat integrates
• Cost: see our fat transfer cost guide

Cheek implants — the surgical structural option

For patients with substantial volume loss where filler or fat would require very large volumes, or for patients whose underlying bone structure is inadequately prominent regardless of soft tissue, cheek implants provide permanent structural augmentation.

The procedure uses solid silicone implants placed through small intra-oral incisions, positioned over the cheekbone, and secured. The result is permanent enhancement of the underlying bony framework. Once placed and healed (typically 6-8 weeks), the implants don’t change with time.

Advantages: permanent, structural, doesn’t require maintenance.

Disadvantages: surgical procedure with associated risks (infection, malposition, palpability), permanent commitment, less natural feel than fat transfer.

Cheek implants are appropriate for a specific subset of patients with genuine bony structural deficiency, not for most patients with age-related cheek hollowing. Most patients are better served by filler or fat transfer.

Mid-face lift

For patients whose cheek hollowing is accompanied by descent of the mid-face — the cheek tissue has both lost volume and slipped downward — a facelift or specific mid-face lifting procedure may be appropriate.

This isn’t a treatment for sunken cheeks alone — it’s a procedure for combined volume loss and tissue descent. The technique repositions descended cheek tissue back to its original anatomical position, restoring fullness through repositioning rather than volume addition.

Mid-face lift is appropriate for patients with:

• Combined cheek hollowing and visible mid-face descent
• Jowling along with the cheek hollowing
• Significant skin laxity in addition to volume loss
• Patients past the threshold where filler alone delivers enough improvement

For the broader surgical options, see our guides on SMAS facelift, deep plane facelift, and mini facelift.

For the head-to-head comparison of when filler vs surgery is appropriate, see our guide on dermal fillers vs facelift surgery.

Biostimulators for skin quality alongside volume

For patients whose sunken cheek appearance is accompanied by poor skin quality (crepiness, thin skin, surface ageing), bioremodelling treatments improve dermal quality alongside whatever volume restoration is performed:

Profhilo — bioremodels skin through high-concentration HA injection at specific anchor points. Improves elasticity, hydration, and overall skin quality. See our comprehensive Profhilo guide.

Polynucleotides — DNA-fraction injections that stimulate fibroblast activity and improve dermal quality through different biological mechanisms.

Skin boosters (Redensity 1 and others) — combined HA, amino acid, antioxidant, and mineral injections for surface skin improvement.

These don’t address volume directly but improve the surrounding skin quality, making the volume restoration look more natural.

Energy-based skin tightening

For patients whose cheek appearance is affected by skin laxity in addition to volume loss, energy-based treatments can tighten and improve the skin alongside other treatments:

Fotona4D — dual-wavelength laser including intra-oral pass. Tightens skin and improves quality.

Morpheus8 — radiofrequency microneedling for deeper skin tightening.

FaceTite — radiofrequency-assisted lipolysis for more substantial skin tightening with about a week of recovery.

These can be combined with filler or fat transfer for comprehensive non-surgical mid-face rejuvenation — see our non-surgical facelift hub for the broader treatment philosophy.

Who suits which approach?

The right treatment depends on the dominant cause:

Mild to moderate age-related volume loss: cheek filler, often combined with skin treatments.

Substantial volume loss in younger patients: fat transfer for longer-lasting restoration.

Post-weight-loss hollowing: filler or fat transfer depending on extent; cheek implants in selected cases.

Genetic predisposition with otherwise normal facial proportions: filler or cheek implants depending on the patient’s preferences for reversibility vs. permanence.

Combined volume loss and mid-face descent: surgical mid-face lift, possibly combined with fat transfer.

Volume loss with significant skin quality concerns: combined plan including filler/fat transfer + biostimulators + energy-based treatments.

A consultation establishes which combination matches your specific anatomy and goals.

How to fix sunken cheeks naturally — what works and what doesn’t

Worth being direct, because this is heavily searched and heavily misinformed.

Facial exercises do not restore facial volume. “Face yoga” and cheek-toning routines are marketed for this and cannot work mechanically: the hollow is caused by loss of fat volume and, over time, bone beneath it. Neither responds to exercising the muscles that sit between them. If anything, significant facial muscle hypertrophy would change contour in ways most people do not want.

Massage, cupping and gua sha move fluid temporarily. Any change lasts hours, not weeks, and none of it rebuilds volume.

Dehydration genuinely does make it look worse — which is why the appearance can vary day to day, and why people notice it more after alcohol or illness. Correcting dehydration will restore the appearance you had when properly hydrated. It will not fill a hollow that is there when you are.

Collagen supplements have some evidence for skin hydration and elasticity. They do not replace fat-compartment volume, which is the actual cause here.

What does genuinely help: stopping smoking, since smoking accelerates both collagen breakdown and fat-compartment loss; maintaining a stable weight rather than cycling; daily sun protection, because photoageing degrades the dermal support around the hollow; and avoiding very low body fat if facial appearance matters to you. None of these reverse existing hollowing — they slow what is coming.

If your cheeks are already hollow and it bothers you, the honest position is that restoring volume requires putting volume back: filler, fat, or an implant. Nothing applied to the surface or done with the muscles achieves it.

Lifestyle factors that genuinely matter

For all patients with sunken cheeks, several lifestyle factors significantly affect both appearance and treatment longevity:

Body fat percentage. Very lean body composition produces facial hollowing. For patients whose cheek hollowing is partly weight-related, modest weight gain (or moving away from extreme leanness) can produce meaningful improvement.

Stable weight. Avoiding weight cycling — repeated loss and gain — protects facial fat from chronic atrophy. The face is one of the most weight-sensitive areas of the body.

Sun protection. Daily SPF 30+ on the face protects against the UV damage that accelerates both volume loss and skin quality changes. The single highest-impact preventive measure.

Stop smoking. Smoking accelerates facial volume loss dramatically. Stopping smoking doesn’t reverse existing damage but substantially slows further deterioration.

Limit alcohol. Chronic high alcohol intake depletes facial fat and damages skin quality. Moderation helps.

Sleep position. Sleeping consistently on one side can produce subtle facial asymmetry over decades, though this is minor compared to other factors.

Stress management. Chronic stress accelerates aging through multiple mechanisms. Genuine stress management produces real long-term benefits.

These habits don’t eliminate sunken cheeks but slow further loss and extend the duration of treatment results.

Cost summary

• Fat transfer to face: see our fat transfer cost guide
• Cheek implants: quoted at consultation
• Mid-face lift: see our facelift cost guide (often as part of broader facelift)

Prices for these treatments are on our Skin & Aesthetics price list.

Finance options through Chrysalis Finance are available, subject to status, across all treatments.

Frequently asked questions about sunken cheeks

Can sunken cheeks be reversed naturally?

For weight-related hollowing, modest weight gain can restore some volume. For age-related or genetic hollowing, no lifestyle intervention restores the underlying volume — only treatment does.

Will filler in my cheeks make my face look “puffy” or “overfilled”?

Not when conservatively dosed. The aim is restoration of natural projection, not maximalist enhancement. Overfilled cheeks typically result from years of accumulating filler without appropriate dissolving — the cumulative effect rather than any single treatment.

How long until I see results from cheek filler?

Immediate visible improvement. Final result at 2 weeks once swelling resolves.

What if I want my filler removed?

HA cheek filler can be dissolved with hyaluronidase within 24-48 hours. This is one of the safety advantages of HA filler over permanent alternatives.

Is fat transfer painful?

The donor site (liposuction area) is more uncomfortable than the recipient site for several days. Both heal predictably with appropriate aftercare.

Do facial exercises help with sunken cheeks?

Limited evidence. The muscles in question aren’t easily strengthened by deliberate exercise, and even strengthened muscles wouldn’t significantly restore the missing volume. Facial exercises are a low-impact lifestyle intervention without significant downside, but they’re not a treatment for sunken cheeks.

What about volumising skincare?

Topical products work on the outer layers of skin and can improve hydration and surface appearance. They don’t reach the subcutaneous fat compartments where ageing changes actually occur. Topical skincare is a useful adjunct, not a treatment.

Can I combine multiple treatments?

Yes — most combinations work well with appropriate sequencing. A typical combined plan might include cheek filler + Profhilo + Morpheus8 over 2-3 months, with maintenance approximately annually.

If my cheeks are sunken from weight loss, will the treatment work?

Yes — filler or fat transfer can effectively restore volume lost through weight loss. The treatment effect doesn’t depend on the original cause. However, future weight stability matters — significant subsequent weight loss can affect the result.

At what age should I consider treatment?

Treatment is appropriate whenever the appearance bothers you and your anatomy is suitable. There’s no specific age threshold. Patients in their 30s, 40s, 50s, and beyond all have cheek treatment performed routinely. The technique and product choice are tailored to your specific anatomy and goals.

What does sunken cheeks mean?

Sunken or hollow cheeks describe a concave area beneath the cheekbone where the cheek has lost its forward fullness, giving the face a gaunt or tired look. Underneath, it reflects reduced soft-tissue volume in the mid-face: fat, and over time sometimes bone. It is a description rather than a diagnosis, so the useful next question is why it has happened — ageing, genetics, weight loss, medication or, less often, illness.

Are hollow cheeks genetic?

Often, yes. Cheekbone projection, the shape of the zygomatic arch and the amount of fat in the mid-face are largely inherited, so some people have hollow cheeks from their teens or twenties with no ageing or weight change involved. Genetic hollowing is usually symmetrical and stable for years, which makes it predictable to treat: cheek filler where soft tissue is thin, or a structural option such as fat transfer or implants where the bony framework is the issue. Inherited hollowness is also the main reason to avoid buccal fat removal.

Can dehydration cause sunken cheeks?

Yes, temporarily. Dehydration reduces the water content of the skin and soft tissue, so the face looks drawn and existing hollows look deeper — which is why cheeks can look worse after illness, alcohol or a long run. The effect reverses once fluids are restored. If the hollowing is still there when you are well hydrated, it is volume loss rather than dehydration. Sunken eyes and cheeks with dizziness, confusion or passing very little urine is a medical problem: contact NHS 111, or 999 in an emergency.

Why do I have a dent in one cheek?

A dent on one side usually has a local cause: a previous steroid injection at that spot, an old injury, acne scarring that has tethered the skin, a natural dimple, or filler that has moved or been partly dissolved. Less commonly it is localised scleroderma or Parry–Romberg syndrome, which progress slowly over months and can affect skin, fat and bone. A dent that is spreading, or that appeared without an obvious reason, should be checked by your GP or a dermatologist before any cosmetic treatment.

References

1. Stankov MV, Panayotova-Dimitrova D, Leverkus M, Schmidt RE, Behrens GMN. Thymidine analogues suppress autophagy and adipogenesis in cultured adipocytes. Antimicrobial Agents and Chemotherapy 2013;57(1):543–551. doi:10.1128/AAC.01560-12 ↗
2. Sharma RK, Gupta M, Rani R. Delineating injectable triamcinolone-induced cutaneous atrophy and therapeutic options in 24 patients: a retrospective study. Indian Dermatology Online Journal 2022;13(2):199–206. doi:10.4103/idoj.idoj_483_21 ↗
3. Ueno K, Huang CW, Fukui M, Chou PY, Chen YR. Parry-Romberg syndrome: a novel treatment algorithm derived from long-term follow-up and more than 40 years of surgeon’s experience. International Journal of Oral and Maxillofacial Surgery 2026;55(11):1327–1334. doi:10.1016/j.ijom.2026.05.010 ↗
4. Fontdevila J, Guisantes E, Martínez E, Prades E, Berenguer J. Double-blind clinical trial to compare autologous fat grafts versus autologous fat grafts with PDGF: no effect of PDGF. Plastic and Reconstructive Surgery 2014;134(2):219e–230e. doi:10.1097/PRS.0000000000000409 ↗
5. Narasimhan K, Ramanadham S, Rohrich RJ. Face lifting in the massive weight loss patient: modifications of our technique for this population. Plastic and Reconstructive Surgery 2015;135(2):397–405. doi:10.1097/PRS.0000000000000881 ↗

---

Centre for Surgery · CQC-regulated · GMC-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 020 7993 4849 · Book a consultation · Finance available, subject to status

Related Articles

• How To Age Well – Top Tips for Maintaining a Youthful Look
• Anti Wrinkle Injections vs Facial Fillers
• How Young is Too Young for Anti Wrinkle Injections?