Autologous Fat Grafting versus Hyaluronic Acid Fillers for Cheek Augmentation: A Prospective Cohort Study Comparing Outcomes and Considerations

Introduction: Cheek augmentation is a popular aesthetic procedure, with autologous fat grafting (lipofilling) and hyaluronic acid (HA) fillers being the most common techniques. This study aimed to compare the clinical efficacy, complication rates, and psychological impact of lipofilling versus HA fillers for cheek augmentation. Materials and Methods: A prospective cohort study was conducted from August 2024 until August 2025 at the University of Sulaimani and one private clinics in Iraq. Forty adult women seeking elective cheek augmentation were enrolled and allocated to either lipofilling (n=20) or HA filler (n=20) groups. Outcomes were assessed using the FACE-Q Satisfaction with Cheeks module, Global Aesthetic Improvement Scale, Derriford Appearance Scale-24 (DAS-24), and standardized photography at multiple timepoints up to 12 months. Complications and psychological effects were systematically recorded. Results: The mean age was 32.25 ± 4.40 years (filler) and 36.55 ± 4.58 years (lipofilling). Satisfaction was high in both groups, with 100% of lipofilling and 85% of filler patients "very satisfied" with cheek appearance. Complications were more frequent in the lipofilling group (asymmetry 10%, swelling 55%, donor site bruising 15%) compared to the filler group (bruising 50%, p≤0.001). Lipofilling showed higher evenness satisfaction (75% vs. 35%, p=0.025) and better DAS-24 scores, indicating improved psychological adaptation. Conclusion: Both lipofilling and HA fillers are effective for cheek augmentation, with lipofilling offering more natural and even results but a higher minor complication rate. Individualized treatment selection is recommended.