Deep nasolabial folds, hollow cheeks

Why Do Smile Lines Deepen and Cheeks Become Hollow?

The midface consists of superficial and deep fat compartments supported by the cheekbones. With age, mild bone resorption occurs in the zygoma, retaining ligaments loosen, and fat pads atrophy and descend—causing the midcheek to hollow while the displaced fat accumulates along the nasolabial folds, making them appear deeper and casting shadows. Rapid weight loss, smoking, and excessive sun exposure accelerate this process. Younger individuals with naturally low cheekbones or a lean facial structure may also have prominent smile lines even without significant aging.

Why Shouldn't Filler Be Injected Directly into the Smile Lines?

The fold deepens because the midface tissue above it has sagged, not because the fold itself is simply "lacking" volume. Directly injecting large amounts of filler into the nasolabial fold may fill the crease, but the cheeks remain hollow, leaving the lower face looking heavy and the smile unnatural or stiff. The anatomically sound approach is to restore volume to the cheekbones and midcheek to provide structural lift from above, allowing the folds to soften naturally; only a minimal amount is placed directly in the crease if still needed. Furthermore, the facial artery runs through the nasolabial region, making proper injection technique and the use of a blunt cannula essential for safety.

HA Filler vs. Autologous Fat Grafting?

Hyaluronic Acid (HA) Fillers: Provide immediate results, allow volume adjustments across sessions, naturally dissolve over 12–18 months, and can be reversed with hyaluronidase if necessary. Ideal for moderate volume loss and those trying treatment for the first time. Autologous Fat Grafting: Uses your own fat (harvested from the abdomen or thighs) to restore volume to the cheeks, making it suitable for significant volume loss and long-term results; however, a portion of the transferred fat will be reabsorbed within 3–6 months—requiring overcorrection or touch-ups—and involves a longer recovery period with swelling.

What Factors Determine the Outcome?

The degree of volume deficit, concurrent skin laxity (severe laxity cannot be corrected by fillers alone and may require thread lifting or surgery), underlying bone structure, age, and appropriate product dosage—overfilling leads to an unnatural, "puffy" appearance.

How Does BonBoz Approach Smile Lines and Sunken Cheeks?

Our aesthetic dermatologists evaluate the face both at rest and during dynamic facial expressions (smiling), assess areas of volume loss and skin laxity, and capture standardized clinical photographs. The preferred approach focuses on structural midface lifting using HA fillers administered via cannula, using conservative amounts and staged sessions if necessary; autologous fat grafting or a referral to a plastic surgeon is recommended in cases of severe volume loss or pronounced skin laxity. Injections are performed directly by our physicians, with longevity, vascular risks, and safety management protocols thoroughly discussed prior to the procedure.