Hollow cheeks are characterized by a defined contour line or a subtle indentation below the cheekbones, creating a sculpted aesthetic. This appearance results from a complex interplay between inherited traits and external influences. Genetics establish the foundational structure of the face, but modifications from aging, body weight, and specific anatomical fat deposits determine the degree of fullness or hollowness. Understanding the relative contribution of each element clarifies why some individuals naturally possess this defined look while others develop it over time.
The Foundation of Facial Genetics
The blueprint for a person’s facial shape, including the potential for hollow cheeks, is largely established by inherited skeletal structures. Genes dictate the size and projection of the zygomatic arch, or cheekbone, which forms the upper boundary of the cheek area. A more prominent zygoma naturally creates a shadow or contour beneath it, giving the impression of hollowness even with normal soft tissue volume.
Genetic inheritance also influences the depth and width of the midface structure, including the maxilla, or upper jawbone. A naturally narrower or less protrusive midface provides less underlying support for the overlying soft tissues, which can genetically predispose an individual to a more sunken or defined look.
Beyond bone, the inherited pattern of where subcutaneous fat is stored is relevant to facial appearance. Some individuals are genetically programmed to store very little fat in the face, contributing to a naturally leaner appearance. This inherent distribution pattern, combined with the skeletal framework, accounts for the significant variability in cheek fullness observed among people of the same age and body mass index.
The Anatomy of Buccal Fat Pads
A specific and highly influential factor in cheek contour is the volume of the buccal fat pads (BFP), which are distinct masses of adipose tissue deep within the cheeks. These pads are encapsulated and located between the muscles of mastication. The size of the BFP is largely genetically determined and is often resistant to changes in systemic body weight.
Unlike the superficial fat compartments, the BFP do not easily shrink with diet or exercise. A person with genetically large pads will maintain a fuller, rounder mid-cheek appearance. Conversely, individuals predisposed to having smaller BFP exhibit a naturally hollower, more sculpted contour even at a healthy body weight. The precise volume of these pads is a major determinant of mid-cheek indentation.
Because the size of the BFP does not correlate with an individual’s overall body fat percentage, it provides a direct anatomical explanation for why some thin people have full cheeks and some average-weight people have naturally hollow cheeks. Variations in the size of this deep fat deposit are a clear example of how genetics influence the specific distribution of fat in the face.
Lifestyle and Age-Related Changes
While genetics provide the initial framework, several non-inherited factors modify the appearance of cheek hollowness over a lifetime. Aging is a primary modifier. The midface skeleton undergoes bone resorption, where the maxilla and orbital bones lose volume and projection over time.
This loss of underlying bony support contributes to a less defined facial contour and exaggerates hollowness. Furthermore, the superficial fat pads of the face tend to atrophy, or decrease in volume, and descend. The combined effect of bone loss and fat redistribution creates the characteristic sunken look associated with aging.
Significant weight loss will also contribute to a more defined or hollow look. Although the deep buccal fat pads are resistant, the loss of subcutaneous fat beneath the skin’s surface reduces the cushioning layer, increasing the visibility of the underlying bone structure. Lifestyle factors, such as chronic dehydration, smoking, and excessive sun exposure, accelerate the breakdown of collagen and elastin, diminishing skin elasticity and support. Certain medical conditions, including severe malnutrition or diseases that cause lipoatrophy, can also lead to a rapid loss of facial volume, resulting in sunken cheeks.