Saggy Cheeks: Causes, Symptoms & Treatments

Over the years, we experience various changes in our face. Fine lines around the eyes, faint scars on the lip edges and sagging, which we call “sagging”, occur especially in the cheek area. It can make our face look more tired or mature. But don’t worry: today it is possible to take precautions against sagging cheeks and remedy the problem with many surgical and non-surgical methods.

Causes	– Loss of collagen and elastin in the skin – Relaxation of tissue under the influence of gravity – Reduction or displacement of fat tissue – Genetic predisposition – Environmental factors such as sun exposure and smoking
The symptoms	– Drooping face (jowl formation) that becomes apparent on the jawline – Rounding of facial features – Hollowed cheeks or loss of facial contour
Methods of prevention	– Use of sunscreen – Healthy diet (foods rich in antioxidants) – Regular moisturizing care – Use of collagen and elastin-supporting skincare products – Avoiding smoking and alcohol consumption
Non-surgical treatments	– Botox: Helps prevent sagging cheeks by reducing muscle movement. – Filler injections: Fills in depressions and restores facial contour. – Radiofrequency and ultrasound (HIFU): Tightens skin by stimulating collagen production. – Thread lift: Provides skin restoration with a minimally invasive method.
Surgical treatments	– Facelift surgery (Rhytidectomy): Gives a youthful appearance by repositioning the facial and neck tissue. – Fat transfer: Fat tissue in the body is used to fill in the loss of volume in the face.
Time for recovery	– For non-surgical methods, the recovery period is usually limited to a few days. – For surgical treatments, it can take several weeks to fully recover.
Risks and complications	– Bruising of the skin, swelling – Infection (in surgical procedures) – Unnatural appearance or asymmetry – Loss of sensitivity or nerve damage (in rare cases)

What is cheek sagging?

Cheek sagging is a downward displacement of the soft tissue (skin, fat and muscle layers) in the central part of the face. As a result of partial loss of skin elasticity and weakening of the underlying structures over time, the cheek line loses its prominence and the facial oval looks more angular and tired. If we explain this with an analogy: Imagine a fresh sponge in the kitchen. When you first buy it, it’s hard and firm, but as it absorbs water, it swells and after a period of use, it becomes a little worn and can’t maintain its shape as well as before. The structures inside our skin also go through similar processes.

Sagging cheeks are often part of the natural aging process, but it can also be seen in some people at an early age. A slight sagging in the early period can show up as a significant collapse or sagging in later periods. For example, if the line between the cheek and chin (nasolabial area) has deepened or if the ‘marionette lines’ (lines running down from the corners of the mouth) are prominent, this may be due to a downward displacement of the cheek tissue.

The earliest signs of sagging cheeks can be seen in your late 30s or early 40s. However, as everyone has a different skin texture, genetic factors, lifestyle and history of sun exposure, it is not possible to give an exact age. Therefore, it is very important to know the causes and take precautions, no matter how early sagging cheeks start.

What causes sagging cheeks?

Sagging cheeks occur when several different mechanisms interact. Sometimes the loss of skin elasticity plays a more dominant role, while other times it’s the displacement of fatty tissue or a decrease in muscle strength that comes into play. Let’s now take a closer look at these factors.

• Reduced elasticity in the skin

Our skin contains two basic proteins called collagen and elastin. Collagen acts as the “skeleton” that keeps the skin intact, while elastin gives the skin flexibility with its ability to stretch and relax. As we age, the body’s production of these proteins slows down and the existing proteins break down or deteriorate in quality. This situation causes the skin to not show the resilience it once did. The skin is pulled downwards by gravity and begins to sag. Just as a worn elastic band loses its elasticity, the elasticity of our skin also decreases.

• Changes in subcutaneous fat tissue

When we are young, the fat tissue in the face is more evenly distributed with more volume in the upper part of the cheeks. As we age or experience weight fluctuations, the fat distribution in the face changes. In some areas, the fat tissue becomes thinner or shifts downwards, while in other areas there may be an accumulation of fat. This imbalance can cause the cheeks to deflate or, on the contrary, gather in the lower parts and give a sagging appearance.

• Reduced muscle function

The facial mimic muscles provide support for the skin and fatty tissue. Muscle mass can also diminish or lose its strength due to aging. Especially when the strength of the “lip seal” or other mimic muscles decreases, there is not enough muscle support in the cheek area and sagging worsens.

• The effects of gravity

Gravity is actually effective at every moment and in every tissue in life. No matter how strong the skin structure and underlying supporting tissue is, there is a downward pull in the long term. This shrinkage, combined with the loss of elasticity and fatty changes mentioned above, creates a visible laxity.

• Natural aging process and changes at the cellular level

The cells in our skin wear down over time and the accumulation of senescent (older) cells increases. These cells produce some enzymes that can damage healthy tissue and substances that contribute to the formation of inflammation. Ultimately, this leads to a deterioration in skin quality and an accelerated loss of collagen and elastin.

• Genetic and other factors

If you have a family history of early cheek sagging or skin elasticity issues, you may also have this tendency. In addition, lifestyle factors such as excessive exposure to sunlight, air pollution, unhealthy diet and smoking can accelerate the process.

Who is at higher risk of sagging cheeks?

Although sagging cheeks are seen in many people, there are some groups that have a higher risk:

• Familial predisposition: If your mother, father or other close relatives have early skin sagging, your risk is genetically increased.
• Excessive sun exposure: The sun’s ultraviolet (UV) rays break down collagen and elastin fibers in the skin and weaken the skin, which can lead to premature sagging.
• Smokers: The chemicals in cigarettes disrupt blood circulation and reduce the transportation of oxygen and nutrients to the skin. This is associated with early wrinkling and sagging.
• Rapid weight loss or weight gain: Sudden weight changes negatively affect the subcutaneous fat tissue. Especially with rapid weight loss, the subcutaneous support decreases and the skin can sag because it does not keep up with the tightening.
• Advanced age: With age, there is a natural slackening of the skin and underlying support tissue.
• People with disturbed sleep patterns and a stressful lifestyle: Cell renewal slows down in a body that doesn’t get enough rest and stress hormones reduce skin quality.

What are the symptoms of sagging cheeks?

Sagging cheeks sometimes start with very mild symptoms. The first signs may be a slight deflation of the previously plump cheekbones, the cheeks not lifting as before when smiling, or the nasolabial lines (the line that runs from the edge of the nose to the corner of the mouth) becoming deeper. In the following periods, the following symptoms may become more pronounced:

Reduced cheek contour: When standing in front of the mirror, you may notice that the midline of the face is flatter or droops more than before.

Sunken appearance: A hollowing of the upper part of the cheeks can occur due to loss of volume, which can contribute to the formation of a tired look.

Deepening of the corner of the mouth: These lines, also known as “marionette lines”, go down from the corner of the mouth to the jawline, creating an expression where the person looks unhappy or sad.

Jowl formation: In some people, the tissue under the cheeks can sag and cause a slight drooping on the sides of the chin. This makes the face look more square or heavy.

Can sagging cheeks be prevented with lifestyle changes?

Yes, it is possible to slow down or alleviate the rate at which cheeks sag by developing some basic habits. For example

• Providing sun protection

Protecting your skin from the sun significantly reduces the loss of collagen and elastin that can occur in the future. Measures such as using a sunscreen with a protection factor of at least 30 SPF before going out in the sun and wearing a hat or sunglasses are very effective in this regard.

• Limit smoking and alcohol consumption

Smoking constricts capillaries and provides less oxygen to the skin. Alcohol also reduces skin elasticity as it dehydrates the body. Therefore, quitting smoking and reducing alcohol consumption can help you maintain your skin quality.

• Balanced nutrition and regular exercise

When your body is healthy, your skin looks healthier too. Vegetables and fruit, whole grains, healthy fats (e.g. fish oil, olive oil, avocado) and adequate protein intake support collagen production in the skin. Regular exercise increases blood circulation and provides more oxygen and nutrients to the skin.

• Adequate water consumption

Keeping skin moisturized is important to maintain its elasticity. While an average of 2 liters of water per day is an appropriate amount for most people, you can adjust this amount according to your daily activity level and environmental conditions.

• Reduce stress and get enough sleep

A stress-free life is of course not possible, but learning activities (yoga, meditation, hiking, etc.) or techniques to reduce your stress also helps the skin renew itself. In addition, 7-9 hours of quality sleep at night supports the skin’s repair processes.

• Posture and sleeping position

If you sit hunched over all day, your cheeks and jaw can easily succumb to gravity. Getting the right sitting and posture habits can protect your skin in the long run. Sleeping on your back instead of sleeping face down can also reduce pressure on the cheek.

Are home exercises helpful for sagging cheeks?

In recent years, the popularity of so-called “facial yoga” or “facial exercises” has increased. Several studies have suggested that some simple exercises in particular can help strengthen the cheek muscles and lift the cheek contour slightly. These include, for example

Cheek lift:

• Open the lips to form the letter “O”.
• Curl your upper lip slightly back towards your teeth.
• Smile slightly and try to lift your cheek muscles upwards.
• Hold this movement for a few seconds and work your cheek muscles thoroughly.

Sculpting happy cheeks:

• Keep your lips closed, smile without showing teeth.
• Push your cheek muscles upwards as much as possible.
• Place the fingers of both hands lightly over the corners of your mouth and support the movement by sliding your fingers upwards.
• Stay in this position for 20 seconds.

The logic of this type of exercise is to provide a small increase in muscle mass by exercising the cheek muscles regularly and supporting the skin to make it tighter. However, to see the effects of the exercises, it is necessary to exercise regularly for several weeks. It’s also important to know that it won’t create a miracle on its own. This method can play a supportive role in mild sagging, but it is not sufficient in cases of advanced sagging.

How effective can skincare products be against sagging cheeks?

Skincare products are usually in the form of creams, serums or lotions and contain substances such as collagen, elastin, peptides, antioxidants or hyaluronic acid. Some of these products can provide a temporary firming effect on the skin and increase moisture levels. But you can’t expect them to completely eliminate deep tissue laxity. Their protective and supportive properties are more important:

Retinoids (Retinol): Accelerates cell renewal and supports collagen production. With regular use, you can see an improvement and a slight tightening of the skin’s surface.

Peptides: Promotes protein production in the skin. Specially designed peptide complexes that can contribute to collagen synthesis can help increase skin resilience with long-term use.

Antioxidants (vitamin C, vitamin E, etc.): Reduces skin damage by neutralizing free radicals and supports the protection of collagen fibers.

Hyaluronic acid: Increases the skin’s ability to retain moisture, can ease the appearance of fine lines and gives a plumper appearance.

If you want results with these products, regular and long-term use is essential. In other words, it’s unrealistic to use any cream for a week and expect a miracle. In addition, the quality of the ingredients, their suitability for your skin and the formulation technology are also very important. Incorrect or excessive use can lead to unwanted effects such as irritation or acne.

What are the non-surgical treatment options?

If the sagging skin is not yet advanced or if the person is avoiding surgery, more controlled approaches are possible with many technologies and methods that have been developed in recent years.

• Applications of fillers (dermal fillers)

Hyaluronic acid-based fillers are often preferred to eliminate volume loss and support the skin, especially in the center of the face and cheeks. The filler works on the logic of replacing the missing fatty tissue. This makes the cheeks look fuller and lifted. The procedure usually takes 15-30 minutes and the effect can vary between 6 months and 2 years on average.

• Botulinum toxin (Botox)

Botox is best known for removing wrinkles in the forehead and around the eyes. However, some doctors may also inject small doses of Botox into certain muscle groups in the cheek area to slightly regulate muscle tension. This can help alleviate sagging cheeks, but may not have a very noticeable effect on its own.

• Energy-based skin lifting methods (HIFU, RF, lasers)

HIFU (high-intensity focused ultrasound): It triggers collagen production by increasing heat in the lower layers of the skin with focused ultrasound waves.

Application of radiofrequency (RF): It promotes tightening, especially by heating the skin and subcutaneous tissue.

Laser treatments: Some types of lasers can help reduce the loss of elasticity in the skin by stimulating collagen production.

Good results can be achieved for mild to moderate laxity with these methods. However, 1-3 sessions are usually required and the effect is more pronounced over time (a few weeks to a few months).

• Facelift with threads (thread lift)

The threads are placed under the skin to provide support to lift a specific area. The threads can also stimulate collagen production in the skin. The effect can last for approximately 12-18 months. Recovery is faster than surgery, but the results are not as long-lasting as a full facelift.

What surgical methods can correct sagging cheeks?

Surgical procedures are a good option for people with advanced cheek sagging or those who want permanent and more dramatic results. Of course, these methods require greater risk, cost and recovery time. But they can provide very successful results when performed in experienced hands.

Facelift (Facelift / Ritidectomy)

SMAS (Superficial Musculoaponeurotic System) lift: The aim is to achieve a younger facial contour by tightening the muscle-fascia layer (SMAS) on the cheek and jawline.

Deep-Plane Facelift: This provides a more comprehensive lift. Deeper facial tissues are also lifted and replaced. This way, the center of the face, cheeks and nasolabial folds are corrected more effectively.

Compzite Facelift: This is a slightly extended version of the Deep-plane technique; it provides holistic rejuvenation in different areas of the face, including the eye area.

Midface Lift (cheek lift)

It focuses on repairing laxity in the center of the face rather than the lower face and neck. Generally, the cheek fat tissue is fixed by pulling the cheek fat tissue upwards with incisions made from the edge of the lower eyelid or inside the hairline.

Implants in the cheekbone (malar)

Implants can be placed on the cheekbones when there is a lack of volume in the cheek area, when the bone structure is too far back, or to strengthen the overall facial contour. This can partially camouflage the sagging appearance by emphasizing the cheekbones.

Bichectomy (buccal fat pad removal)

Sometimes excessive fullness in the cheek contributes to a sagging appearance. Surgical removal of these fat pads can slim the cheek contour and give a more lifted appearance. However, in some people this surgery can lead to a complete loss of volume in the center of the face and give an aged appearance in the long term. Therefore, it is important to be selective.

As with all surgical methods, there are risks such as infection, bleeding, nerve damage and anesthetic reactions. Therefore, the chosen method should be decided together with a specialized plastic surgeon and expectations should be realistically assessed.

What is the durability of fillers and other applications?

Hyaluronic acid fillers are permanent for an average of 6 to 18 months. This period varies depending on the person’s metabolism, the quality of the filler and the area of application. Although some fillers are more permanent (up to 2 years), their density is also higher and their use in highly mobile areas like the cheeks requires the right product selection.

The effect of Botox usually lasts for 3-6 months and is often not used alone to treat sagging cheeks. Methods such as RF, HIFU, laser can be effective for 6 months to 1 year after 1-2 sessions; skin collagen production can be supported by repeating at regular intervals.

The effect of thread stretching methods can last 12-18 months on average. While the threads are absorbed by the body over time, they also stimulate collagen production. However, as the skin continues its natural aging process, it may not provide a completely permanent solution.

What is the healing process in Cheek Sagging Aesthetics?

The healing process for surgical procedures (e.g. facelift) usually takes 2-4 weeks. Edema, bruising and discomfort are normal for the first few days. Special bandages or protective clothing recommended by the doctor after surgery will help maintain the new face shape. During recovery, it is necessary to avoid heavy exercises, not to consume alcohol and cigarettes and to go for regular check-ups.

With non-surgical procedures (fillers, botox, RF, HIFU, rope stretching) it is much faster to return to everyday life. Generally, you can return to work or social activities immediately after the procedure or within 1-2 days. There may be some slight redness, swelling or bruising, but this is usually temporary.

When is it necessary to consult a professional?

When you feel uncomfortable: If you experience a lack of confidence or unhappiness due to a sagging face, you can get a professional assessment of the problem and learn about possible solutions.

When you think you need more advanced treatments: When creams, home exercises or other simple treatments aren’t enough, consider switching to more effective methods.

When you notice sudden or excessive sagging: If you notice that you are sagging much faster than the normal aging process, it could be another health issue (edema, weight loss, etc.). It is important to consult a doctor to assess this.

To clarify your expectations: you should definitely see a specialist to get all the information you need about surgical or non-surgical treatments, to develop realistic expectations and to understand the risks.

The importance of motivation in the prevention and treatment of cheek prolapse

When it comes to aesthetics and appearance, people can sometimes start to feel in an unnecessary race. “Filtered” photos on social media, perfect celebrity skin, timeless faces… Of course, these may be exaggerated examples that don’t correspond to reality. Therefore, if you are considering treatment for sagging cheeks, remember that your first goal is to “become a better version of yourself”. The following points can help in this process:

Realistic expectations:

No method will make you 20 years younger, but it can give your face a more vibrant and dynamic look.

Small steps:

You can start with non-surgical methods and continue if you’re happy with the results. Or if you’re so flabby that you should consider surgery, consult a good plastic surgeon for a comprehensive evaluation.

Choosing an expert:

The right technique should be chosen according to your skin type and needs. Competent specialists will guide you both physically and psychologically throughout the process.

Follow-up and maintenance:

Regular check-ups, proper home care and maintenance of healthy lifestyle habits are necessary to maintain the effects of the procedure.

What role do nutrition and supplements play in sagging cheeks?

As the skin is our largest organ and needs a large number of vitamins and minerals in the regeneration processes, our eating habits are an important support in the fight against sagging cheeks.

Protein sources (fish, eggs, chicken, legumes): Contains amino acids necessary for collagen formation.

Antioxidant-rich fruits and vegetables (orange, strawberry, tomato, spinach, etc.): Protects skin cells from free radicals.

Healthy oils (olive oil, avocado, walnut, etc.): Strengthens the skin’s moisture barrier.

Water consumption: It prevents the skin from drying out and wrinkling.

In addition, collagen and hyaluronic acid supplements have become popular in recent years. There is not yet much strong scientific evidence that these supplements directly provide significant skin tightening, but some studies cite cases of limited benefit. Some people report that they experience brighter and healthier skin, especially when taking hydrolyzed collagen supplements. Nevertheless, it is useful to consult a specialist before using these supplements.

Is it possible to do something about sagging cheeks?

Sagging cheeks are a natural part of aging, but it doesn’t have to be our “destiny”. Today, it is possible to control this process and revitalize our face with skincare, lifestyle measures, surgical or non-surgical methods. If you wish, you can make a small improvement with small interventions, or you can opt for surgical methods for more significant results.

Prioritized, preventive approach: Sun protection from a young age, avoiding smoking, regular exercise and a balanced diet help to keep your skin healthier and more supple in the long term.

There are various treatment options: there are alternatives to surgery thanks to methods such as fillers, botox, thread lift, HIFU, radiofrequency and laser. In advanced cases, more satisfying and long-term results are achieved with surgeries such as facelift or mid-face lift.

Professional opinion required: Especially if advanced procedures are planned, it is important to get an opinion from a dermatologist or plastic surgeon. As every face, skin type and expectation is different, you can determine the most precise treatment by consulting your specialist.

If you say: “Sagging cheeks bother me, I want to feel more energized, I want to reduce the tired look on my face”, you can get professional treatments on the points deemed necessary and start with lifestyle changes. Remember, the goal should be to bring health and freshness to your face rather than looking younger or “someone else”. After all, it can be possible to feel better about yourself, even with a small change to your appearance.

The first step you should take when dealing with sagging cheeks is to properly understand the causes of it. It is in your hands to control some of these causes (e.g. quitting smoking, sun protection, healthy nutrition). For the factors we can’t control (genetic or natural aging process), there are medical and aesthetic solutions. When choosing the right method, it’s healthiest to work with a specialist and take into account both scientific data and your own comfort.