How Can a Sunken Midface Be Corrected?

Hello, I’m Dr. Jo Hyun-woo of 입체성형외과.

Today, let’s look at ways to address a sunken midface.

The midface refers to the central part of the face, including the area under the eyes, the front of the cheekbones, and the area beside the nose.

If this area is sunken, the face may appear flat overall or give a tired, older-looking impression.

In fact, many of the people who come in for consultations say things like, “Why does my face look so sunken?” or “I keep being told I look tired.”

So why does this happen, and what are the solutions?

In this post, I will organize the causes of midface hollowing and possible treatment options step by step, based on academic evidence and actual clinical experience.

Causes of Midface Hollowing

1. Skeletal structural factors

A common pattern seen in East Asians is that when the maxilla is recessed, the area around the nose and mouth looks flat, creating the impression of a sunken midface.

In addition, if the cheekbones do not project forward enough, the cheeks may not provide enough three-dimensional support, making the face look hollow. If the jaw is prominent, the midface may appear comparatively more sunken as well.

2. Soft tissue factors

As we age, the retaining ligaments that support the face loosen, allowing tissues to move downward under gravity. At the same time, the malar fat pad decreases and sags.

In addition, as collagen and elasticity decrease, the skin becomes thinner, making the hollowing more noticeable.

3. Acquired causes

After cheekbone reduction surgery, volume may decrease as the bony structure changes, or hollowing may occur due to excessive fat removal.

It can also result from traffic accidents, trauma, or congenital facial skeletal abnormalities.

How to Correct Midface Hollowing - Non-Surgical Approaches

1. Filler injection

Advantages: The procedure is simple and shows immediate results; volume and placement can be adjusted as needed

Disadvantages: Duration is limited to 6–12 months; if overfilled, it may cause a foreign-body sensation, asymmetry, or vascular complications

Academic evidence: A recent study (J Clin Aesthet Dermatol, 2022) found that fillers showed a significant effect in improving age-related midface flattening.

2. Autologous fat grafting

Advantages: Because it uses the patient’s own tissue, there is almost no immune reaction, and long-term effects can be expected if some of the graft survives

Disadvantages: Some absorption occurs, and bruising and swelling after the procedure require a recovery period

Clinical experience: Patient satisfaction is high, but secondary touch-up grafting is often needed.

3. Thread lifting

Advantages: Minimal incisions and fast recovery

Disadvantages: The effect usually lasts only 1–2 years

Best use: Effective for younger patients with mild hollowing and accompanying sagging.

How to Correct Midface Hollowing - Surgical Approaches

1. Pyriform augmentation

Method: Insert silicone, Gore-Tex, PCL implants, or similar materials into the hollow area beside the nose

Advantages: Permanent volume restoration

Disadvantages: Foreign-body sensation from the implant, infection, and possible displacement

Suitable candidates: Most effective when the maxilla is recessed.

2. Midface lift

Principle: Lifts the sagging fat pads under the eyes and in the front cheek area, returning them to their proper position.

Advantages: Can improve both hollowing and sagging at the same time

Disadvantages: Being a surgical procedure, it requires a recovery period

Evidence: According to a plastic surgery journal (Plast Reconstr Surg, 2020), the midface lift showed superior results in restoring facial contour and a youthful impression compared with simple volume replacement.

3. Cheekbone reconstruction and augmentation

If the cheekbones are set back, structural improvement can be achieved by fixing an implant over the bone.

If cheekbone surgery has already been performed, some restoration toward the original cheekbone shape may be possible if the amount of bone removed was not too large.

Midface hollowing is not just a cosmetic issue; it greatly affects facial proportions, three-dimensionality, and even first impressions.

There are many different solutions, but the approach should vary depending on the patient’s skeletal structure, age, skin condition, and desired results.

It is important to find the method that is most appropriate for you through 충분한 상담 with a specialist.

I hope today’s information helps you find an answer if you have been 고민ing over a sunken face.

Thank you.