Plumped up Cheeks with Botox or Filler?

Another Botox question in a public forum:

Fluffy cheeks with botox or filler?

Hello i am 37 years of age. I want my cheeks become fluffly as i was used to look in young age. Which treatment would b better botox or filler ? And how much is cost? Thanks.

My Botox Answer:

I get this type of question of Botox or Fillers every single day – so it’s a great question.


​Last month I had the honor of treating 127 patients with Botox, and 31 patients with a dermal filler.  I think 1/4 of these patients wondered about the differences between Botox and Fillers.  And in my practice, the usage of Botox is a lot more than the usage of fillers.


​I came up with this explanation for my patients and perhaps it will help others.  First imagine our face as having a landscape.  We have mountains and valleys in our face.  The valleys being the wrinkles which are usually surrounded by mountains on either side.  I have told my patients that Botox weakens muscles and thus it will give the appears of lowering the mountains on our face.  But Fillers, will help to fill up the valleys.  Thus if we want an even surface – a combination approach might be needed: we might have to lower the mountains with Botox (those bulging muscles!) and we might have to raise the level of the valleys/wrinkles with Fillers.


The filling/raising of a structure on the face requires a Filler.  Thus for bigger, fluffier cheeks, we need a filler.


​There are many fillers.  The filler that is very popular in the cheek is Juvederm Voluma.  But I still consider off-label FDA choices of other fillers in the cheeks for my desired appearance or a combination of fillers.  I use Belotero, Juvederm ultra plus XC, Juvederm ultra XC​, and Radiesse in the cheeks.  I also use thinned out versions of Juvederm by purposely diluting the products.  All this is considered off-label FDA, but this helps me get the results I envision along with my patient’s goals.

​My plastic surgeon wife who is in practice with me has certain permanent implants which she can use in surgery.  But that would be a totally different topic which I’ll let her explain.


​What is used for making bigger cheeks Filler or Botox? The answer is Filler.  I try to explain that Botox actually shaves down the appearance of bumps in the face, and filler raises lowered areas on the face.  But if we want to raise a bump (mountain) on the face – that would also be fillers.  Naturally the next question might be which filler would we choose.  I think my go-to filler right now is Voluma for the cheek.

​Thank you for your question. Without having seen you in person, I’m answering the best I can without physical examination info. My comments are meant for a general public discussion to help others who may have similar concerns. I’m also using my answers to build up library of information for my own patients and also to see how my answers compare with other doctors. There is always much for us to learn from each other. My answers are generalized medical information only, not directed medical advice. For medical advice please see your doctor/surgeon in person.

​Calvin Lee, MD
​Botox and Juvederm in Modesto, California

Modesto Surgeons at work