Causes and Improvement Methods for Cheek Sagging

The sagging type (where excess tissue has descended) and the volume-deficient type (where tissue has been lost, causing hollowing) are distinguished by the location of shadows. In the sagging type, the jawline contour becomes blurred and tissue accumulates in the lower areas like the nasolabial folds and marionette lines, whereas in the volume-deficient type, the area below the cheekbones and the center of the cheeks become hollow, creating a tired and aged appearance.

As a simple self-check, lie down while holding a mirror or tilt your head back. If your facial contour becomes clearer, the sagging type (due to gravity) is more prominent; if the hollow appearance remains, the volume-deficient type is more prominent. In reality, the two types are often mixed, so an accurate assessment of the ratio requires a specialist's diagnosis.

The order depends on the main cause. For the combined type that requires both, the general sequence is to perform lifting first and then replenish volume later. If volume is added while the tissue is still lax, the added weight may accentuate sagging. By lifting first to reposition the tissue, only the remaining hollow areas need to be filled, which also reduces the amount of volume required.

Conversely, for the volume-deficient type with pronounced hollowing, it may be a priority to first restore support with Sculptra, JUVELOOK Volume, or HA Filler. The sequence and interval vary depending on the degree of sagging, skin thickness, and type of procedure, so rather than a fixed answer, the treatment should be designed to address the underlying cause.

Home care can help prevent and maintain cheek sagging, but it has limited effect in lifting already descended cheek tissue.

The key aspects of home care are using sunscreen to prevent collagen breakdown, applying retinoid ingredients to support dermal collagen production, and avoiding rapid weight fluctuations.

Massage or home devices may temporarily reduce puffiness for a slimmer appearance, but they do not reach the deep fat layer and ligaments that cause sagging. As part of post-procedure care, in-clinic management programs such as the EVE Synergy facial, which stimulates the muscle layer with EMS and microcurrent, can be used as a supplementary approach.

Combining lifting and volume procedures is recommended.

For the sagging type, treatments targeting the SMAS layer, such as Ultherapy PRIME® (ultrasound), or those that tighten dermal collagen, such as Thermage® FLX (radiofrequency), are commonly performed.

For the volume-deficient type, we recommend replenishing hollow areas with HA Filler or RADIESSE®, or gradually building collagen volume with Sculptra or JUVELOOK Volume.

For the combined type, a two-step treatment is recommended: first, address laxity with lifting, then add volume to any remaining hollow areas. Even for the same cheek sagging, the optimal combination varies depending on fat volume, skin thickness, and the stage of sagging. We recommend consulting with a dermatologist to design the sequence and combination that suits your cheeks.