Treatment Options for Cheek Augmentation – Fillers vs Fat

Cheek augmentation is a commonly searched facial treatment, and the questions behind most searches are the same: which option is right, how long does it last, what does cheek augmentation surgery involve and how long is the recovery? Cheek enhancement can mean a short cheek filler appointment, an operation using your own fat, or a solid implant over the cheekbone. Each does something different.

This guide explains the options, who each suits, how the procedures are done, what recovery looks like and what the risks are. If your cheeks look hollow rather than flat, our guide to sunken cheeks covers the causes, and if your concern is skin that has dropped, saggy cheeks and the facelift page explain why volume alone will not fix it.

Centre for Surgery is a CQC-regulated private hospital on Baker Street, and the surgeons who assess you are GMC-registered. We offer dermal fillers, facial fat transfer and cheek implants, so your advice is based on what suits your face rather than on any one treatment.

What Is Cheek Augmentation?

Cheek augmentation, sometimes called cheek enhancement, malar augmentation or cheekbone augmentation, adds volume or projection to the mid-face. In a youthful face the cheek is full just below the lower eyelid and gives the face a gentle oval or heart-shaped outline. That fullness can be missing from birth because of the shape of the cheekbone, or it can fade over time as the fat pads of the mid-face deflate and the bone slowly recedes. A flatter cheek can make the face look longer, more tired or older than you feel, and it can alter the balance between the eyes, nose and chin.

Cheek augmentation does not lift loose skin. It adds support where support is missing. Our guide to high cheekbones vs low cheekbones explains how to tell where your own cheekbones sit, and how the face ages over time shows what changes in the mid-face from your thirties onwards.

What Are the Types of Cheek Augmentation?

There are three main ways to augment the cheeks. A review of cheek augmentation in gender-affirming facial surgery lists the same three groups: fillers, fat grafting and alloplastic (man-made) cheek implants^[4].

Cheek fillers

Cheek filler is a hyaluronic acid gel placed deep on the cheekbone or at the front of the cheek to add projection or fill a hollow. It is the least invasive option, the result is visible straight away and it can be adjusted or, if you are unhappy, dissolved with hyaluronidase. As it is temporary, it is also a sensible way to find out whether fuller cheeks suit you before committing to something permanent. Our cheek fillers page covers the technique, and dermal fillers shows the other areas that can be treated at the same visit, such as the tear troughs, temples and jawline.

Facial fat transfer to the cheeks

Facial fat transfer, also called fat grafting or lipofilling, takes fat from the tummy, flanks or thighs by gentle liposuction, purifies it and injects it in tiny amounts into the cheeks. It uses your own tissue, so there is no foreign material in the face. Around 60 to 70% of the grafted fat typically survives and stays. An expert review of facial fat grafting techniques found that fat seems to take well where fat loss is the problem, such as the cheek, the area around the eyes and the jaw^[7]. A 2018 systematic review in Aesthetic Plastic Surgery ↗ of 19 studies found that the average volume placed in the midface was about 1.4 mL per side, so the amounts involved are small and are built up in layers^[6]. Read more on the facial fat transfer page, and see is facial fat transfer permanent? for what happens to the fat over time.

Cheek implants

A cheek implant, also called a malar or zygomatic implant, is a solid, shaped piece of silicone placed over the cheekbone. A review of mid-face skeletal enhancement describes alloplastic malar augmentation as a permanent but reversible way to enhance the mid-face, most often placed through the mouth and held in position with a stitch^[1]. Implants may sit directly on the cheekbone (malar), just below it (submalar), or combine the two, and sizes and shapes vary, so the choice is made with your surgeon at consultation. Cheek implants are the right choice for a small group of people, and our guide to facial implants vs fillers compares them with the alternatives across the face.

Who Is a Good Candidate for Cheek Augmentation?

You are more likely to be a good candidate if you are an adult in good general health, you can describe what you want to change, and your expectations are realistic. In practice, two groups account for most people we see.

• Cheeks that have lost volume. Hollowing under the cheekbone, a flatter mid-face or a tired look, often after weight loss or with age, suits filler or fat transfer. Facial changes after rapid weight loss are a common example of fat loss in the mid-face.
• Cheekbones that were always flat. If the underlying bone has never projected much, soft filler can only do so much, and a cheek implant gives a structural change. A review of solid mid-face implants makes this point directly: implants provide a stable support that fillers often cannot^[2].

Who should not have cheek augmentation?

Cheek augmentation is not the right treatment if the main problem is loose skin, jowls or a heavy lower face. Adding volume to a face that has dropped can make it look fuller rather than lifted. You may also be advised to wait if you smoke or vape, are pregnant or breastfeeding, have an active infection in the area, or want a result that no cheek treatment can deliver. For surgery, we ask you to be a non-smoker or stop all nicotine for four weeks before and four weeks after.

Are Cheek Implants Better Than Fillers?

Neither is better in general. They solve different problems. Cheek implants add a fixed structural change to the bone line, and filler adds soft, adjustable volume that fades. In a 2023 comparison of malar implants and fat transfer in Annals of Plastic Surgery ↗, 97.7% of people who had implants were satisfied compared with 87% after fat transfer, and two people with implants had complications against none with fat. The study was of transfeminine patients, followed for an average of under four months, so it cannot be applied directly to everyone, but it supports the view that implants give a more definite change while fat transfer is a reasonable option for smaller enhancement^[3].

In practice the choice comes down to four questions:

• How permanent do you want it to be? Filler fades, fat transfer is long-lasting and an implant is permanent unless removed.
• How much change do you want? Subtle softening suits filler, and a clearly higher cheekbone suits an implant. See facial fat transfer vs fillers for the first two.
• How much downtime can you accept? Filler is a lunchtime treatment, whereas an implant means taking time off.
• Are you comfortable with an operation? If not, filler is a sensible first step, and you can still move on to fat transfer or an implant later.

At Centre for Surgery, our surgeons generally reserve cheek implants for people with genuinely flat cheekbones. For age-related hollowing, filler or fat transfer usually looks more natural and carries less risk.

Do Cheek Implants Lift the Face?

Not in the way a facelift does. A cheek implant projects the cheekbone forward and gives the tissues above the jawline a firmer base, which can make the mid-face look fuller and slightly more supported. It does not remove loose skin or reposition jowls. Where tissue has dropped, a mini facelift, facelift or deep plane facelift repositions it, and FaceTite tightens mild laxity. Our dermal fillers vs facelift surgery guide covers when volume is enough and when a lift is needed. Anti-wrinkle injections relax muscles to soften lines and do not add volume, so they complement cheek filler rather than replace it, and the liquid facelift combines several injectable treatments in one plan.

How Is Cheek Augmentation Performed?

The steps depend on the option you choose. A surgeon assesses you in person, plans the treatment with you and, where an operation is involved, a two-week cooling-off period follows your consultation so that you have time to think.

How are cheek implants placed?

Cheek implant surgery typically takes around an hour. It is done under TIVA (total intravenous anaesthesia, given through a drip) or local anaesthetic with sedation, and your surgeon and anaesthetist confirm which at consultation. Our anaesthesia guide and what is TIVA explain the options. The surgeon marks the cheek, usually makes a small incision inside the mouth, creates a pocket over the cheekbone, places the implant, secures it and closes the incision with dissolvable stitches. A transoral approach is the most commonly used for this operation, and the stitch or fixation stops the implant shifting while the tissues heal^[1]. Cheek implants can be combined with other facial surgery such as a facelift or brow lift, and our jaw implant vs chin implant guide covers the lower face.

How is fat transfer to the cheeks done?

Facial fat transfer takes about 1.5 to 2.5 hours and is done under local anaesthetic with sedation for small volumes or under TIVA for larger or combined cases. A small amount of fat is taken through a tiny incision, purified and injected in fine droplets in layers. You go home the same day with a compression garment over the donor site, and an adult needs to collect you and stay with you for 24 hours. Our fat transfer results guide explains what helps the fat survive.

How are cheek fillers given?

Cheek filler is given after numbing cream, usually with a fine cannula through one small entry point on each side. The appointment is short, you can usually return to normal activities and you are reviewed around two weeks later.

How Long Is the Recovery After Cheek Augmentation?

Recovery depends almost entirely on the option you choose.

Recovery after cheek implants

Expect swelling and bruising for the first days, and your face will look fuller than the final result at first because the swelling sits on top of the implant. Many people return to desk work within about a week, although this varies, and you should avoid strenuous exercise for at least six weeks. Your surgeon may ask you to wear a facial support garment, particularly in the first week. Numbness or altered sensation around the cheek is common and usually settles over weeks to a couple of months. As the incisions are inside the mouth, you will be given advice on keeping the area clean and on what to eat. Avoid pressure on the cheeks, rubbing or massage until your surgeon says it is safe, as the implant needs to settle. The final result takes several months to appear. If implants are combined with a facelift, our facelift recovery guide applies.

Recovery after fat transfer to the face

Swelling peaks around day 3 and visible swelling and bruising take about two weeks to largely settle, so plan for two to three weeks of visible recovery. The donor area is mildly sore and is supported by the garment. Some of the fat is absorbed in the first weeks, so the final shape is judged after a few months. Our fat transfer recovery guide has a week-by-week outline.

Recovery after cheek filler

Most people return to work the same day or the next. Swelling peaks at 24 to 48 hours and is mostly gone within a week, and any bruising usually fades within a week or occasionally two. Avoid make-up on the injection points for 24 hours, and avoid alcohol and strenuous exercise as advised.

How Long Does Cheek Augmentation Last?

It depends on the option. Hyaluronic acid cheek filler is broken down by the body over months. In a 2015 single-blind controlled trial in Dermatologic Surgery ↗ of 235 adults with mid-face volume loss, a volumising filler gave correction that lasted 15 to 24 months depending on the area treated, with the longest in the front of the cheek, using about 2 mL in total^[5]. At Centre for Surgery, filler results usually last 12 to 18 months, and the exact time depends on the product, your metabolism and the amount used.

Fat transfer results last for years once the surviving fat has a blood supply, although the evidence for how long is more limited than for filler, and a 2022 review of cheek augmentation notes that evidence for long-term fat survival is lacking^[4]. Implants do not fade, but your face continues to age around them.

What Are the Risks and Downsides of Cheek Augmentation?

Every option has risks, and the ones that matter depend on what you choose.

• Cheek implants: infection, an implant that moves or sits asymmetrically, visible or palpable edges, numbness, and the possibility that you will want to change or remove it later. Reviews list infection, migration and visibility as the main implant-related complications^[4].
• Fat transfer: swelling, lumpiness, unpredictable fat survival, a second session if needed, and the usual risks of liposuction at the donor site. Over-correction is harder to reverse than with filler.
• Cheek filler: bruising, swelling, lumps, migration and, rarely, a blocked blood vessel. A literature review of 50 reports of filler-related visual loss found that the greatest risk came from nasal augmentation, followed by treatment between the eyebrows, and no reports from the temples or chin^[8]. The cheek is not among the highest-risk areas, but serious complications can happen after any facial filler injection, which is why injector training and having hyaluronidase on site matter.

Can cheek implants be removed?

Yes. Implants are permanent in the sense that they do not wear off, but they can be removed or replaced with a further operation. This reversibility is one reason surgeons describe them as permanent but reversible^[1]. A second operation carries its own recovery and risks.

What happens to cheek implants as you age?

The implant stays the same size while the soft tissues around it change. If the skin loosens or the cheek fat drops, the implant may become more visible, and a lift can be added later. This is one reason implants are not recommended for sagging cheeks.

How Much Does Cheek Augmentation Cost in the UK?

The cost of cheek augmentation depends on the option and on your face, so a single figure would be misleading. For filler, the price depends on how much product you need, and Centre for Surgery’s published filler prices are listed on our Skin & Aesthetics price list. For cheek implants and fat transfer, the quote depends on the operating time, the type of anaesthetic, whether the implants are combined with other surgery, whether fat is taken from one or more donor areas and the size and type of the implants. Medicines and garments may be separate. Our fat transfer cost guide explains the factors. Your price is confirmed in writing after an in-person consultation, and finance options are available, subject to status.

What Results Can You Expect From Cheek Augmentation?

The aim is a face that looks balanced and rested rather than obviously changed, which is also how cheeks are used in facial feminisation surgery, facial asymmetry correction and profileplasty. Good cheek augmentation is subtle: the cheek sits slightly higher and fuller, the shadow under the eye is softer, and the smile line is a little less deep. Poor results usually come from too much volume, an implant that is too large or in the wrong position, or a plan that treated the wrong problem. Ask to see before and after photographs of patients with a similar face to yours.

Cheek augmentation often works well as part of a plan. A fuller cheek can soften the hollow under the eye (see tear trough filler) and improve the balance between the cheeks, chin and nose. If the concern is a rounded, full lower cheek, buccal fat removal does the opposite, and a lip lift or eyelid surgery may complement the result. Our guide to features of a beautiful face explains how proportions are judged.

What Happens at a Cheek Augmentation Consultation?

At Centre for Surgery, the surgeon who assesses you in person is the surgeon who treats you. You can expect to:

• discuss what you want to change and what you want to avoid
• have your face examined from the front and side, including the cheekbone, the fat pads, your skin and your bite and jaw where relevant
• hear which options suit you, including options we do not recommend and the option of doing nothing
• be told the risks, the recovery and what a realistic result looks like
• receive a written plan and quote, with a two-week cooling-off period before any surgery

Treatment takes place at our hospital at 95 to 97 Baker Street, a CQC-regulated setting, with direct access to the clinical team in the early recovery period.

Frequently Asked Questions

Cheek Augmentation in London

If you are thinking about cheek augmentation, a consultation with a surgeon will establish whether volume, bone shape or loose skin is behind the change in your cheeks and which treatment suits you. Find out more about cheek fillers and facial fat transfer.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Soares DJ, Silver WE. Midface skeletal enhancement. Facial Plastic Surgery Clinics of North America 2015;23(2):185–193. doi:10.1016/j.fsc.2015.01.004 ↗
2. Dhir K, Binder W. Solid midfacial implants: when fillers are not enough. Facial Plastic Surgery 2016;32(5):480–487. doi:10.1055/s-0036-1587596 ↗
3. Chaya BF, Rodriguez Colon R, Diep GK, et al. Comparative outcomes of malar implants versus fat transfer to cheeks among transfeminine individuals undergoing malar augmentation. Annals of Plastic Surgery 2023;90(6S Suppl 5):S457–S461. doi:10.1097/SAP.0000000000003491 ↗
4. Jumaily JS. Cheek augmentation in gender-affirming facial surgery. Otolaryngologic Clinics of North America 2022;55(4):825–834. doi:10.1016/j.otc.2022.05.004 ↗
5. Glaser DA, Kenkel JM, Paradkar-Mitragotri D, Murphy DK, Romagnano L, Drinkwater A. Duration of effect by injection volume and facial subregion for a volumizing hyaluronic acid filler in treating midface volume deficit. Dermatologic Surgery 2015;41(8):942–949. doi:10.1097/DSS.0000000000000416 ↗
6. Shue S, Kurlander DE, Guyuron B. Fat injection: a systematic review of injection volumes by facial subunit. Aesthetic Plastic Surgery 2018;42(5):1261–1270. doi:10.1007/s00266-017-0936-6 ↗
7. Donofrio LM. Techniques in facial fat grafting. Aesthetic Surgery Journal 2008;28(6):681–687. doi:10.1016/j.asj.2008.09.003 ↗
8. Lee W, Koh IS, Oh W, Yang EJ. Ocular complications of soft tissue filler injections: a review of literature. Journal of Cosmetic Dermatology 2020;19(4):772–781. doi:10.1111/jocd.13213 ↗