Malar means the cheekbone area. Doctors also call this the midface, because it sits in the middle third of the face, between the lower eyelid and the upper lip.
Descent means drooping downward with time. So malar / midface descent means the cheek tissues slowly slide down, losing their high, full, lifted look.
When we are young, the cheekbone (the zygomatic bone) is covered by firm skin, springy connective tissue, and neatly arranged fat pads. Together they make a smooth, gentle S-shaped curve called the Ogee curve (a soft high point under the outer eye, then a smooth slope toward the mouth). As we age or after illness or injury, several things happen at once:
The skin loses collagen and elastin (the fibers that give skin strength and stretch).
The retaining ligaments (little “tethers” that hold skin to deeper structures) loosen, so the skin and fat can slide.
The fat pads in the cheek may shrink, shift, or clump.
The bone under the cheek can thin or resorb (the cheekbone “platform” becomes smaller).
Some muscles pull more strongly in certain directions, which can deepen folds.
All of this makes the cheek look flatter on top and heavier lower down, especially near the nasolabial fold (the smile line from the nose to the corner of the mouth). The lower eyelid–cheek junction also looks longer and more “separated,” which many people read as a tired look.
Why this matters
Midface descent is not dangerous by itself, but it can:
Make the face look tired, sad, or older than it is.
Make the nasolabial folds and marionette lines look deeper.
Reduce support under the lower eyelid, which may show as tear troughs, hollows, or malar bags/festoons (puffy folds on the upper cheek).
Change light reflection on the face so shadows appear where highlights used to be.
Understanding what it is—and what it is not—helps you choose sensible evaluation and, if you ever want them, treatment options.
Types of malar / midface descent
Age-related midface descent
This is the most common type. Skin thins, ligaments loosen, cheek fat shifts downward, and cheekbone support slowly reduces with years. Gravity does not cause all of it, but it reveals the changes by showing where tissues slide.Soft-tissue–dominant descent
The main problem is in the skin, ligaments, and fat pads. Bone is okay, but the soft parts sag. You see a softer cheek “peak,” deepening smile lines, and early jowls.Bone-structure–dominant descent
The cheekbone platform is small (some people are born this way) or loses volume with age or tooth loss. With a weaker “scaffold,” even small soft-tissue changes look bigger.Medial (inner) cheek descent
The inner part of the cheek (near the nose) flattens first. This shows as tear troughs and medial cheek hollow.Lateral (outer) cheek descent
The outer cheek (over the zygomatic arch) drops more. The face loses its side highlight and can look narrower and heavier lower down.Static descent
The droop is visible even when the face is relaxed and still.Dynamic descent
The droop or fold shows more with expression, like smiling or squinting, because moving muscles push loose tissues into deeper creases.Symmetric descent
Both cheeks change similarly. This is common with general aging.Asymmetric descent
One side looks lower. Causes include past injury, dental issues on one side, sleeping mostly on one side, or mild nerve weakness.Early (mild) descent
Subtle flattening of the upper cheek with early shadowing and light deepening of the smile lines.Moderate descent
Clear loss of cheek height, noticeable nasolabial folds, longer lid–cheek junction, and beginning lower-face heaviness.Severe descent
Strong flattening above with heavy tissue below, festoons may be visible, and the lower face looks full while the upper face looks deflated.True ptosis vs. “pseudo-ptosis”
In true ptosis, tissues slide or sag because supports loosen. In pseudo-ptosis, the cheek looks droopy because of swelling (edema), fat herniation, or volume loss above, not only because of sliding.Primary vs. secondary descent
Primary happens naturally over time. Secondary follows another event, like trauma, surgery, massive weight loss, or radiation.With lower-eyelid involvement vs. without
Some people mainly get tear troughs and festoons with the cheek droop; others have cheek droop but the lower eyelid still looks supported.
Causes
Natural aging
Collagen and elastin decline; ligaments loosen; fat pads change position; bone slowly resorbs. Together, this lowers the cheek.Sun (UV) damage
UV breaks down collagen and elastin, speeding skin laxity and fine wrinkles, which makes descent more visible.Genetics
Some people inherit a flatter cheekbone or looser connective tissue, so the midface looks lower earlier.Large weight loss
Fat pads shrink. When upper-cheek fat reduces, the area above looks flat and the area below looks relatively heavier.Smoking
Nicotine and toxins reduce blood flow and collagen production, thinning the skin and making it sag sooner.High sugar / glycation
Sugar can stiffen collagen through glycation, reducing skin elasticity and speeding folds.Hormonal changes (menopause/andropause)
Estrogen and testosterone influence collagen content and skin thickness. A drop can thin and loosen skin.Bone resorption
The cheekbone (zygomatic complex) and maxilla can thin with age, so the soft tissues lose a firm platform and slide.Tooth loss and dental bite changes
Losing teeth or having a collapsed bite reduces midface projection; the cheek then looks lower and the upper lip flatter.Chronic allergies or sinus problems
Constant rubbing, swelling, or mouth breathing can irritate tissues and worsen lower-eyelid support and malar bags.Chronic edema (fluid retention)
Fluid in the malar area can make festoons. Over time, swelling stretches skin and weakens support.Poor nutrition / low protein
The body needs protein, vitamin C, zinc, copper, and iron to make collagen. Low levels weaken skin and ligaments.Dehydration
Dry skin looks thinner and crêpey, which exaggerates shadowing and the look of droop.Repetitive facial expressions
Smiling and squinting are good, but over years they can fold mobile skin along the same lines, deepening creases.Sleeping mostly on one side
Long-term pressure can shape soft tissues. The “pillow side” may look a bit flatter or heavier.Previous surgery or over-aggressive fat removal
Removing too much fat or scarring supports can unbalance the midface, making descent more obvious.Facial nerve weakness (even mild)
If muscles that lift the cheek are weak, the cheek on that side can sit lower.Radiation therapy
Radiation can thin skin and reduce blood supply, accelerating laxity and fat changes.Steroid overuse (systemic or frequent local)
Steroids can thin skin and fat and weaken connective tissue, worsening sag.Autoimmune or connective tissue disease
Conditions that attack collagen or fat (for example, some forms of lupus or scleroderma) can change midface support.
Symptoms and signs
Flatter upper cheeks
The high point under the outer eye looks lower or gone.Deepening nasolabial folds
The smile lines from the nose to mouth look deeper even at rest.Tear troughs (hollows under the inner eye)
A line or groove under the lower eyelid becomes more visible.Longer lid–cheek junction
The lower eyelid and cheek no longer blend smoothly; the “step” between them is longer.Malar bags or festoons
Puffy, bag-like folds on the upper cheek, especially in the morning or after salt.Shadowing across the midface
Makeup may settle here; photos show a darker band over the upper cheek.Loss of the Ogee curve
The youthful S-curve is now a flatter line.Heavier tissue around the mouth
The lower cheek looks fuller even if weight is stable.Corners of the mouth look down-turned
Not always from midface alone, but descent above can feed into this look.Asymmetry
One cheek looks lower, especially in selfies or under bathroom lighting.Skin looks thinner and crêpey
Fine lines appear over the upper cheek and lower eyelid.Makeup difficulty
Highlighter does not “catch” as before; blush sits lower than it used to.Tired look despite rest
Friends may ask if you are tired or unwell because light patterns changed.Glasses/frames fit differently
The pad area may press into a lower, softer spot.Smile “pushes up” bulges
When you smile, loose tissue can bunch above the fold, making the fold look deeper.
Diagnostic tests
Important note: There is no single blood test or machine test that “diagnoses” midface descent. Doctors mainly use history, inspection, simple hands-on tests, and photos. Lab and electrodiagnostic tests are used only when they suspect a contributing medical cause (for example, thyroid disease or nerve weakness). Imaging is used when structure detail is needed (for surgery planning, unusual asymmetry, or trauma history).
A) Physical examination tests
Standardized facial photography and visual inspection
You sit with neutral expression under even light. The clinician takes front, 45-degree, and side photos. They look for cheek height, symmetry, fold depth, and light reflection patterns. Photos make before/after comparisons possible and reduce the confusion caused by changing room lights.Ogee curve assessment
The examiner visually traces the gentle S-curve from the lower eyelid to the mid-cheek. A smooth, high curve suggests youthful lift; a flat or broken curve suggests descent.Lid–cheek junction length check
They note the distance from the lower lash line to the point where cheek fullness begins. A longer, sharper step means less support under the eyelid, common in midface descent.Nasolabial fold and medial cheek fullness grading
With relaxed and smiling faces, the clinician grades fold depth and whether soft tissue piles above the fold (a clue that tissue slid from the upper cheek).Canthal tilt and scleral show check
They look at the outer corner of the eye (canthus) and whether white of the eye shows under the iris (scleral show). Increased scleral show with a long lid-cheek step hints at upper-cheek support loss.
B) Manual tests (hands-on)
Two-finger malar lift test
The examiner gently places two fingers over the highest part of the cheek and lifts upward toward the eye. If the face looks refreshed and folds soften, it suggests repositioning of slipped tissue restores the youthful look.Snap-back test (lower eyelid/cheek skin)
The skin below the eye is gently pulled forward and released. Fast snap-back means better elasticity; slow snap-back means laxity that contributes to descent.Pinch test for malar edema/festoons
A gentle pinch over the malar bag shows whether the bulge is fluid, fat, or loose skin. Fluid-dominant bags feel squishy and can shift with pressure.Skin slide test over retaining ligaments
The clinician moves the skin side-to-side to feel where it stops. Abrupt stops suggest retaining ligaments; excessive sliding between them means looser tethers that allow descent.Vector test (positive, neutral, negative)
A vertical line is imagined from the cornea down the cheek. If the cheek projects in front of this line (positive vector), it supports the eye; if the cheek sits behind (negative vector), it lacks projection and often shows early descent.
C) Lab and pathological tests (for contributing causes)
Thyroid function tests (TSH, free T4 ± free T3)
Low or high thyroid hormones can change skin quality and fluid balance, worsening puffiness or laxity. Testing helps if symptoms suggest a thyroid problem (fatigue, weight change, temperature intolerance).Glucose control tests (fasting glucose and HbA1c)
Poor sugar control promotes glycation, which stiffens collagen and reduces elasticity. These labs guide lifestyle or medical care that may slow further skin quality decline.Nutritional and hormone profile (selected, when indicated)
Albumin/prealbumin (protein status), vitamin C (collagen building), iron/ferritin, zinc, and sometimes sex hormones (estrogen/testosterone, DHEA) or cortisol are checked if history hints at deficiencies or hormonal shifts that weaken skin and connective tissue.
These blood tests do not diagnose midface descent. They look for modifiable contributors that might worsen or accelerate it.
D) Electrodiagnostic tests (only if nerve/muscle problems are suspected)
Facial nerve conduction studies
If one side of the face droops more or a past nerve injury is suspected, a nerve study can show signal strength and speed along the facial nerve. True nerve weakness can mimic or worsen descent.Electromyography (EMG) of facial muscles
EMG checks electrical activity in muscles like zygomaticus (smile lifter) and orbicularis oculi (eye-closing ring). Abnormal patterns point to neuromuscular causes of asymmetry or droop.
E) Imaging tests (for structure and planning)
High-frequency facial ultrasound
Non-invasive imaging that can map skin thickness, fat pads, and sometimes retaining ligaments. Helpful for planning procedures and for tracking edema and festoons over time.3D surface scanning / photogrammetry
A camera creates a 3D model of your face. This allows precise measurement of cheek volume and height and objective before/after comparisons.MRI of the midface (selected cases)
MRI shows soft tissues in detail (fat pads, muscles, edema). It is used when findings are unusual, after trauma, or for complex surgical planning.CT or cone-beam CT (CBCT)
These scans show bone best. They reveal cheekbone shape, maxillary bone support, and effects of dental loss—key for understanding the scaffold under the soft tissues.Skin and tissue elastography (ultrasound-based)
Measures stiffness/elasticity of skin and subcutaneous tissue. Lower elasticity correlates with sagging risk and can help document change over time.
Non-pharmacological treatments (therapies & others)
Note: These are device-based, lifestyle, or manual options. They can slow, camouflage, or mildly lift; they don’t replace surgery when descent is advanced.
Daily broad-spectrum sunscreen (SPF ≥30)
Purpose: Protect collagen; slow thinning of skin.
Mechanism: Blocks UV that breaks collagen/elastin; stabilizes pigment and texture over time.
Description: Use every morning, reapply with outdoor exposure; look for UVA (PA rating) and UVB (SPF) coverage.Consistent moisturization with humectants and occlusives
Purpose: Plumper skin surface, better light reflection; fine-line softening.
Mechanism: Humectants (like glycerin, hyaluronic acid) pull water; occlusives reduce water loss.
Description: Layer after cleansing; boosts the “cushion” over cheekbones.Sleep hygiene and pillow strategy
Purpose: Reduce overnight fluid pooling and crease formation.
Mechanism: Head-of-bed elevation and back-sleep decrease pressure on cheek fat pads and under-eye.
Description: Use a side-cut or contour pillow; avoid face-down sleeping.Smoking cessation
Purpose: Preserve collagen and blood flow.
Mechanism: Smoking raises enzymes that break down collagen and constricts vessels.
Description: Stopping slows skin aging and improves healing if you pursue procedures later.Weight stability
Purpose: Avoid rapid fat loss in the face that can worsen hollowness.
Mechanism: Yo-yo weight shifts deplete facial fat pads.
Description: Gentle, steady weight management is kinder to the midface.Low-glycation lifestyle (limit added sugars)
Purpose: Protect collagen cross-links.
Mechanism: Advanced glycation end-products (AGEs) stiffen and weaken collagen.
Description: Favor whole foods; limit sweet drinks and ultra-processed snacks.Lymphatic self-drainage massage (gentle)
Purpose: Reduce malar puffiness in edema-prone people.
Mechanism: Light strokes follow lymph pathways; helps move stagnant fluid.
Description: Use feather-light pressure; stop if irritation or rosacea flares.Allergy management (non-drug strategies)
Purpose: Less under-eye swelling, less rubbing.
Mechanism: Allergen avoidance, saline rinses, HEPA filtration reduce triggers.
Description: Treating allergies often softens malar mounds.Facial muscle balance exercises (with realistic expectations)
Purpose: Tone support muscles; may improve posture of soft tissue a little.
Mechanism: Repetitive, mindful contraction of cheek elevators; reduces overuse of depressors.
Description: Evidence is modest; think “support,” not “lift.”Red/near-infrared LED at-home (cosmetic-grade)
Purpose: Mild boost in collagen quality over months.
Mechanism: Photobiomodulation nudges fibroblasts to produce matrix.
Description: 10–20 minutes, a few times per week; patience required.Professional microneedling (medical-grade)
Purpose: Improve skin firmness and texture; soften grooves.
Mechanism: Controlled micro-injury → collagen remodeling.
Description: Series every 4–6 weeks; downtime is short; avoid if active acne or infection.Radiofrequency (RF) skin tightening (mono/bipolar)
Purpose: Modest tightening of dermis and fibrous septae.
Mechanism: Heat-induced collagen contraction and neocollagenesis.
Description: 3–6 sessions; feels warm; results build gradually.RF microneedling
Purpose: Stronger remodeling than microneedling alone; better for laxity + pores.
Mechanism: Needles deliver thermal energy into dermis/SMAS fascia planes.
Description: 3–4 sessions; some downtime; improves midface tone.Micro-focused ultrasound (MFU/HIFU)
Purpose: Targeted tightening at 1.5–4.5 mm depths (dermis to SMAS).
Mechanism: Thermal coagulation points → collagen tightening.
Description: 1–2 sessions per year; lifting effect is subtle to moderate.Fractional non-ablative lasers (e.g., 1550/1540 nm)
Purpose: Texture and fine-line improvement; small tightening.
Mechanism: Fractional dermal heating stimulates new collagen.
Description: 3–5 sessions; minimal downtime.Chemical peels (superficial to medium)
Purpose: Surface renewal; subtle firming over time.
Mechanism: Controlled exfoliation triggers collagen remodeling.
Description: Glycolic, lactic, salicylic, or TCA (by pros).PDO/PLLA/PLCL thread lifts (office procedure)
Purpose: Temporary mechanical support and collagen stimulation.
Mechanism: Barbed threads hook tissue; polymer stimulates fibrosis.
Description: Results last ~12–18 months; bruising possible; choose experienced hands.Makeup and light-trick camouflaging
Purpose: Instantly restore cheek highlight.
Mechanism: Strategic highlighter above zygoma; contour below to restore “ogee.”
Description: Non-medical but surprisingly effective for photos/events.Posture and screen-time ergonomics
Purpose: Reduce “tech neck/face” downward tilt habits.
Mechanism: Chronic chin-down posture emphasizes gravity’s pull on midface.
Description: Raise screens to eye level; micro-breaks help.Professional skincare plan and follow-up
Purpose: Personalized layering and sequencing for your skin type.
Mechanism: Combining sunscreen + retinoid + antioxidant + moisturizer beats any single product.
Description: Review every 3–6 months; adjust with seasons and procedures.
Drug-based treatments
Important: There is no pill that lifts the midface. “Drug treatments” here mainly means topical medicines and office injectables used in aesthetics. Dosing ranges are typical examples; actual dosing must be individualized by a qualified clinician.
Topical tretinoin 0.025–0.05% (retinoid; nightly as tolerated)
Purpose: Strengthen dermis; soften fine lines; improve texture over months.
Mechanism: Speeds cell turnover; boosts collagen (types I/III); reduces MMP activity.
Side effects: Irritation, dryness, sun sensitivity (use SPF). Start 2–3 nights/week.Topical adapalene 0.1–0.3% (retinoid; nightly as tolerated)
Purpose: Retinoid benefits with often better tolerability.
Mechanism: Similar collagen up-regulation.
Side effects: Mild dryness/peeling; avoid in pregnancy unless cleared by your doctor.Topical tazarotene 0.05–0.1%
Purpose: Potent retinoid for photoaging (more irritation risk).
Mechanism: Strong gene-level stimulation of collagen/elastin.
Side effects: Irritation common; step up slowly; strict photoprotection.Topical vitamin C (L-ascorbic acid 10–20% in water-based, pH ~3)
Purpose: Brightening and collagen support.
Mechanism: Cofactor for collagen cross-linking; antioxidant against UV pollution damage.
Side effects: Sting in sensitive skin; store airtight and away from light.Topical niacinamide 4–10%
Purpose: Barrier support, redness reduction, smoother texture.
Mechanism: Boosts ceramides, reduces inflammation, may decrease glycation by-products.
Side effects: Rare flushing; patch-test first.Topical peptides (e.g., palmitoyl pentapeptide-4, tripeptide-1)
Purpose: Subtle firmness over months.
Mechanism: Signal peptides nudge fibroblasts toward new matrix.
Side effects: Minimal; select reputable formulas.Botulinum toxin type A (injectable; micro-dosing for muscle balance)
Purpose: Relax selected depressor muscles (e.g., DAO) to let elevators show slightly more lift; smooth crow’s feet that accent descent.
Mechanism: Blocks acetylcholine at neuromuscular junction for 3–4 months.
Typical dosing/time: 2–4 units per injection point (varies widely); effect in 3–7 days, peak at 2 weeks.
Side effects: Bruising, asymmetry, temporary smile changes if misplaced; must be injected by experts.Hyaluronic acid (HA) fillers (device but used like a “medication” in practice)
Purpose: Restore cheek projection (malar augmentation) and soften tear-trough/OGE curve.
Mechanism: Adds volume; some products integrate water and subtly stimulate fibroblasts.
Typical dose/time: ~0.5–1.5 mL per side cheek; 0.2–0.6 mL per side tear-trough (by trained injectors), lasting 6–18 months depending on product and plane.
Side effects: Swelling, bruising, Tyndall (blue hue), nodules, edema; rare vascular occlusion/vision risk—choose highly experienced injectors.Calcium hydroxylapatite (CaHA) filler (biostimulatory)
Purpose: Structural lift and collagen stimulation for midface.
Mechanism: Microspheres trigger controlled neocollagenesis.
Typical dose/time: ~0.5–1.5 mL per side; lasts ~12–18 months.
Side effects: Similar to HA; not for very superficial under-eye; avoid intravascular injection.Poly-L-lactic acid (PLLA) biostimulator
Purpose: Gradual volumization for widespread midface thinning.
Mechanism: Biostimulates collagen over months.
Typical dose/time: Usually 1–2 vials per session, 2–3 sessions spaced ~6–8 weeks; results build over 3–6 months, last 2+ years.
Side effects: Swelling, nodules if not properly diluted/massaged; requires skilled injector.
Other injectables sometimes discussed (not counted in the 10): dilute HA “skin boosters,” hyperdilute CaHA for skin quality, and polynucleotides—availability and approvals vary by country.
Dietary, molecular, and supportive supplements
These may support skin quality; they do not “lift” by themselves. Discuss with your clinician—doses here are general adult ranges and may not fit every person.
Collagen peptides (2.5–10 g/day)
Function: Provide amino acids (glycine, proline) for collagen; some trials show improved skin elasticity.
Mechanism: Peptides may signal fibroblasts and supply building blocks.Vitamin C (100–500 mg/day from food/supplement)
Function: Essential cofactor for collagen cross-linking.
Mechanism: Supports stable collagen triple helix; antioxidant.Zinc + Copper (Zinc 8–15 mg, Copper 1–2 mg/day)
Function: Enzyme cofactors in collagen/elastin assembly.
Mechanism: Balance matters—don’t take high-dose zinc without copper.Silicon (as orthosilicic acid) (5–10 mg/day)
Function: May aid collagen synthesis and skin/hair quality.
Mechanism: Supports glycosaminoglycan formation.Hyaluronic acid (oral) (120–240 mg/day)
Function: May improve skin hydration and pliability.
Mechanism: Increases dermal water-binding.Omega-3 fatty acids (EPA/DHA) (1–2 g/day combined)
Function: Anti-inflammatory; supports barrier lipids.
Mechanism: Resolvin pathways; membrane fluidity.CoQ10 (60–200 mg/day with fat)
Function: Antioxidant; may reduce oxidative stress in skin.
Mechanism: Mitochondrial support, scavenges free radicals.Green tea extract (EGCG) (250–500 mg/day or cups of tea)
Function: Antioxidant/photoprotective support.
Mechanism: Reduces UV-induced oxidative stress.Resveratrol (100–250 mg/day)
Function: Antioxidant; may upregulate sirtuin pathways.
Mechanism: Cellular stress-response signaling.Curcumin with piperine (500–1000 mg/day curcuminoids)
Function: Systemic anti-inflammatory support.
Mechanism: NF-κB modulation; antioxidant.Proline + Lysine (as part of protein intake or targeted 0.5–1 g/day combined)
Function: Collagen amino acid building blocks.
Mechanism: Substrates for triple-helix synthesis.Protein sufficiency (≈1.0–1.2 g/kg/day unless contraindicated)
Function: Maintains dermal and muscle tissues.
Mechanism: Supplies amino acids for repair.Niacinamide (oral) (100–500 mg/day; confirm with clinician)
Function: Supports barrier and cellular energy metabolism.
Mechanism: NAD+ pool support; anti-inflammatory.Vitamin D (dose per blood level; commonly 800–2000 IU/day)
Function: Immune and skin health support.
Mechanism: Nuclear receptor signaling.Selenium (55–100 mcg/day)
Function: Antioxidant enzymes (glutathione peroxidase).
Mechanism: Reduces oxidative damage.
Regenerative / stem-cell-style” therapies
Availability and regulation vary by country. Some are well-established (PRP, fat grafting). Others are emerging/experimental (exosomes, SVF enrichment). Always use qualified clinicians and discuss risks.
Platelet-Rich Plasma (PRP) microneedling/injection
Dose/plan: Usually 2–4 sessions, 4–6 weeks apart.
Function: Improve skin quality and fine lines; may help malar skin firmness.
Mechanism: Platelet growth factors (PDGF, TGF-β) stimulate fibroblasts.Platelet-Rich Fibrin (PRF)
Dose/plan: Similar series; releases growth factors more slowly than PRP.
Function: Skin quality and subtle volume in superficial planes.
Mechanism: Fibrin matrix as a slow-release scaffold.Autologous microfat/nanofat grafting
Dose/plan: 5–20 mL processed fat spread in midface planes; may combine with structural fat grafting.
Function: Restores volume and improves skin texture.
Mechanism: Adipocytes + stromal cells integrate; paracrine signaling supports matrix.SVF-enriched fat grafting (experimental in many regions)
Dose/plan: Surgeon-specific; added stromal vascular fraction to fat.
Function: Theoretical better graft survival and regeneration.
Mechanism: Cell-rich graft with growth factor signaling.Exosome-based products (experimental/variable regulation)
Dose/plan: Topical or injected with microneedling protocols.
Function: Claimed collagen signaling; evidence still emerging.
Mechanism: Vesicle-borne RNA/protein signaling to fibroblasts.Polynucleotides/PDRN (availability country-dependent)
Dose/plan: Series of intradermal “skinbooster”-style sessions.
Function: Skin quality, hydration, and possible bioregeneration.
Mechanism: DNA fragments signal repair pathways and hydrate extracellular matrix.
Safety note: “Stem cell” marketing is common. Many offerings are not approved for facial rejuvenation by major regulators. Ask for clear consent, product source, and proof of sterility and approval.
Surgical options (when descent is moderate to severe)
Endoscopic midface lift (subperiosteal)
Procedure: Small incisions hidden in hairline/inside mouth; elevate soft tissues off bone and secure higher.
Why it’s done: Repositions malar fat pad and SOOF; restores cheek contour; improves lower-lid–cheek junction.Deep-plane facelift with midface extension
Procedure: Lifts the SMAS/ligament system as a unit; not just skin.
Why: Strong, natural repositioning for heavier descent; often best for mixed lower-face + midface aging.Lower eyelid blepharoplasty with SOOF/midface elevation
Procedure: Through a lower-lid incision (often inside the lid), the surgeon repositions fat and may elevate midface.
Why: Addresses bags and hollow under-eye together with malar descent.Autologous structural fat grafting (with or without lift)
Procedure: Harvest your fat, refine, and place along cheekbone/OGE curve.
Why: Restores lost projection and curves; can be a stand-alone or combined with lifts.Malar/submalar implants
Procedure: Solid implants placed on the zygoma via small incisions.
Why: Adds permanent cheek projection when bone platform is recessed; useful for flat cheekbones plus descent.
Prevention habits
Daily SPF and hat/shade culture.
Don’t smoke or vape nicotine.
Keep weight changes gentle and steady.
Prioritize protein, vitamin C, and colorful plants on your plate.
Manage allergies and avoid eye/cheek rubbing.
Sleep on your back with slight head elevation.
Limit alcohol and high-salt evenings (reduce puffiness).
Keep screens at eye level; stop the chin-down habit.
Treat skin kindly: no harsh scrubbing or picking.
See qualified pros early; small maintenance beats big fixes later.
When to see a doctor
Plan a visit if the under-eye groove, malar mounds, or cheek flattening bother you and home care isn’t helping after 3–6 months. A dermatologist or facial plastic surgeon can map options that fit your anatomy and budget.
Get checked sooner if fillers from the past caused swelling or lumps (you may need hyaluronidase or other care).
Urgent, same-day care if you have sudden one-sided facial droop, speech trouble, or weakness (possible stroke), or new severe facial pain after trauma (possible cheekbone fracture), or sudden vision changes after an injection (rare emergency).
What to eat and what to avoid
Eat more of:
Lean proteins (eggs, fish, legumes) for collagen building blocks.
Citrus, berries, kiwi, guava for vitamin C.
Colorful vegetables (peppers, leafy greens) for antioxidants.
Nuts/seeds for vitamin E and good fats.
Fermented foods (yogurt, kefir) for skin–gut support.
Whole grains and beans for steady glucose and micronutrients.
Bone broth or collagen-rich soups if you enjoy them.
Avocado and olive oil for skin-friendly lipids.
Green tea as your afternoon drink.
Plenty of water across the day.
Limit/avoid:
Sugary drinks and sweets (glycation).
Heavy alcohol (dehydrates and inflames).
Very salty late-night meals (morning malar puff).
Ultra-processed snacks (low nutrients).
Charred/fried foods (oxidative load).
Smoking/vaping (collagen breakdown).
Constant crash dieting (facial fat loss).
Excess caffeine at night (poor sleep = puff).
Random megadose supplements without guidance.
“Miracle” anti-aging pills—if it sounds too good to be true, it usually is.
Frequently Asked Questions
Can creams lift my cheeks?
Not truly. Good topicals (retinoids, vitamin C, niacinamide) improve skin quality, which can soften the look, but lifting needs devices, fillers, threads, or surgery.Do fillers make malar mounds worse?
They can if placed too superficially or in the wrong area. Under an experienced injector, cheek-bone support (deep, on bone) can improve contour and reduce shadowing.Threads or fillers first?
Depends on your anatomy. If volume loss dominates, filler first. If laxity dominates, threads or energy tightening may come first. Many plans combine them.Will I look “done”?
Natural results come from small, deep, well-placed changes that restore your original curves, not new ones. Choose clinicians who show consistent, natural before/after photos.How long do results last?
Topicals: ongoing. Energy devices: ~1–2 years. Fillers: 6–24 months (product/placement dependent). Threads: ~12–18 months. Surgery: many years, but aging continues.Is HIFU better than RF?
They target different depths. HIFU/MFU reaches deeper (SMAS) for subtle lifting; RF heats dermis/septae for tightening. Some people benefit from a combination.Can facial exercises reverse descent?
They can improve tone and awareness but won’t lift descended fat pads. Think “supportive,” not “curative.”Are exosomes or stem cells the secret?
These are emerging and variably regulated. Some are experimental. Solid, long-term safety/efficacy data are still growing. Proceed cautiously.Do I need surgery?
If descent is mild to moderate, non-surgical plans can help. With advanced sagging or heavier tissues, surgery gives the most reliable repositioning.What is the safest filler for the midface?
Deep, cohesive HA fillers placed on bone by experts are common and reversible with hyaluronidase. CaHA/PLLA are great for stimulation but not for tear-trough areas.Why do I swell under the eyes after flights/salt?
The malar region can trap fluid. Gravity + salt + pressure shifts = transient edema. Elevate your head, hydrate, and reduce salt before events.Will losing weight make my face sag more?
Rapid loss often flattens cheeks. Slow, steady loss is kinder. Volume can later be restored with fillers/fat if desired.How soon after fillers can I see results?
Immediately for HA, but give 2 weeks for swelling to settle. Biostimulators (PLLA, CaHA) build over months.Is there downtime with a midface lift?
Yes. Bruising/swelling for 2–3 weeks is common; full settling takes months. Your surgeon will review your specific plan.What’s the best “starter” plan if I’m overwhelmed?
Daily SPF, nighttime retinoid, vitamin C in the morning, protein-rich diet, and a consult to discuss HIFU/RF and cheek-support filler if needed.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 11, 2025.
