When it comes to facial rejuvenation, subtle changes often yield the most natural and long-lasting results. As we age, two of the most noticeable areas of concern are the midface and the under-eye region. Volume loss in the cheeks and fat descent beneath the eyes can lead to a tired, sunken, or prematurely aged appearance.
While treating these areas individually can be beneficial, combining cheek augmentation with lower eyelid surgery often produces superior, more harmonious outcomes. At ZandifarMD.com, Dr. Hootan Zandifar, a double board-certified facial plastic surgeon, frequently recommends this dual approach to help patients achieve a balanced, refreshed, and youthful look.
In this article, we’ll explore why these two procedures complement each other and how combining them can elevate the results beyond what either treatment can accomplish on its own.
Understanding Facial Aging and Midface Volume Loss
Facial aging is not simply a surface-level issue. It involves deep structural changes, including loss of volume, shifting fat pads, and loosening of skin and connective tissue. One of the most prominent signs of aging is the loss of volume in the cheeks, which causes the midface to flatten and descend. This volume loss doesn’t just affect the cheekbones—it also has a significant impact on the under-eye area.
As the cheek descends, it creates a visible groove or hollow between the lower eyelid and cheek, often called the tear trough or lid-cheek junction. This can make the eyes appear more sunken, emphasize under-eye bags, and contribute to a fatigued or harsh appearance, even in well-rested individuals.
This is why treating only the lower eyelids, without addressing midface volume loss, can sometimes yield incomplete or unbalanced results.
What Lower Eyelid Surgery Addresses
Lower eyelid surgery, or lower blepharoplasty, is a procedure designed to rejuvenate the area under the eyes. It may involve removing or repositioning fat, tightening skin, or adjusting the eyelid muscle to create a smoother contour. It is especially effective for patients with puffiness, under-eye bags, or loose, crepey skin in the lower lid.
However, if midface descent is present, lower eyelid surgery alone may not fully resolve the aged appearance. In fact, in some cases, removing under-eye fat without restoring cheek volume can deepen the hollow and make the face appear overly flat or even skeletal.
This is why integrating cheek augmentation into the surgical plan often provides a more complete and aesthetically pleasing result.
How Cheek Augmentation Enhances Lower Eyelid Surgery
Cheek augmentation restores volume and projection to the malar region (the upper cheekbone area), which lifts the midface and naturally supports the lower eyelid. By filling in the area beneath the eye, it smooths the transition between the eyelid and cheek, reducing the appearance of hollowness and dark shadows.
Dr. Zandifar may use one of several methods for cheek augmentation, including fat transfer, dermal fillers, or cheek implants, depending on the patient’s anatomy, goals, and the longevity of results they’re seeking.
When combined with lower eyelid surgery, cheek augmentation acts as a foundation that enhances the effectiveness of the blepharoplasty, supporting the eyelid structure and preventing postoperative hollowing.
Benefits of Combining Both Procedures
While each procedure has individual merit, combining them offers a number of significant benefits:
Improved Facial Balance and Harmony
The eyes and cheeks are neighboring aesthetic units. When only one is treated, the contrast may draw attention to the untreated area. By addressing both at once, the result looks smoother, more cohesive, and natural—never “done.”
Longer-Lasting Rejuvenation
Lower eyelid surgery tightens and refines the under-eye area, while cheek augmentation restores volume and lift to the midface. Together, these changes provide multi-dimensional rejuvenation that lasts longer and resists age-related changes more effectively.
Reduced Recovery Time
By performing both procedures together, patients benefit from a single recovery period rather than two separate healing processes. This reduces overall downtime and minimizes cumulative swelling or bruising.
Preventing Overcorrection
When the under-eye area is treated without restoring cheek volume, surgeons may feel compelled to remove more fat than necessary. This can lead to a hollow or overcorrected look. Cheek augmentation supports the eyelid from below, allowing for more conservative fat removal and preserving a youthful fullness.
Ideal Candidates for the Combined Procedure
Patients who benefit most from combining cheek augmentation and lower eyelid surgery often present with:
- A deep tear trough or visible under-eye hollow
- Under-eye bags or puffiness
- Flattened or sunken cheeks due to aging or genetics
- A harsh or tired facial appearance despite good health
- A desire for comprehensive, long-lasting rejuvenation
It’s important to have realistic expectations and a desire for natural-looking results. During a consultation, Dr. Zandifar carefully evaluates your facial anatomy, skin quality, and goals to create a plan tailored to your unique features.
Techniques Used in Combined Procedures
Every face is different, which is why Dr. Zandifar personalizes his surgical approach. Cheek augmentation can be achieved in several ways:
- Fat Transfer: Uses your body’s own fat (typically from the abdomen or thighs) to fill in volume around the cheeks and under-eyes. Fat also improves skin quality over time due to its regenerative properties.
- Cheek Implants: Offers permanent structural enhancement for patients with flat or underdeveloped cheekbones.
- Injectable Fillers: Can be used to build soft contour in the cheeks, often as a non-surgical enhancement or to fine-tune results during surgery.
Lower eyelid surgery techniques may include fat repositioning, muscle tightening, or skin excision—all designed to smooth the contour and brighten the eyes.
When done together, these techniques create a lifted, rested, and more youthful appearance that’s balanced and natural—not overdone.
Why Expertise Matters
Combining cheek augmentation with lower eyelid surgery requires precision, deep knowledge of facial anatomy, and artistic judgment. The relationship between the midface and lower eyelid is delicate. Too much correction in one area can imbalance the other. That’s why experience is critical.
Dr. Hootan Zandifar is double board-certified in facial plastic and reconstructive surgery and has years of experience treating both the aesthetic and functional aspects of the face. He understands how to blend surgical techniques for optimal symmetry and long-lasting beauty.
Whether you’re looking to refresh your appearance or reverse signs of aging, Dr. Zandifar delivers tailored care with results that honor your natural features and preserve expression.
Conclusion: A Thoughtful Approach to Timeless Rejuvenation
Facial aging is rarely confined to a single area. That’s why treating multiple, related zones together—like the cheeks and under-eye region—often produces the most satisfying and long-lasting results. By combining cheek augmentation with lower eyelid surgery, patients can achieve smoother transitions, youthful contours, and a refreshed expression that feels entirely their own.
At ZandifarMD, Dr. Hootan Zandifar offers a holistic, individualized approach to facial rejuvenation. His experience, surgical finesse, and dedication to natural outcomes make him a trusted choice for patients seeking refined, elegant results.
📞 Ready to explore your options? Call (310) 278-2080 or visit ZandifarMD.com to schedule your consultation today. Let’s create a look that reflects your energy, your confidence—and your best self.
