Peanut Face: Why Reduction Alone Isn't Enough?

If you've ever looked in the mirror and noticed your cheekbones projecting sideways while your temples appear slightly sunken above them, you're likely looking at what's commonly called a peanut-shaped face. Your side profile may look fairly slender, yet the front view appears flat and wide — making it natural to assume that simply reducing the cheekbones would solve everything. To put it simply, the peanut-shaped face isn't just about the cheekbones themselves. It's a structural issue where volume is lost both above and below the cheeks, which is why reduction and volumizing procedures are often considered together.

The reason this isn't straightforward is that reducing the cheekbones alone can actually make the temporal hollowing above them appear even deeper. That's why understanding what needs to be reduced and what needs to be filled before your consultation can save a lot of confusion.

> This article is an informational content piece about procedures available at Beautystone Clinic in Hongdae.

What you'll learn from this article

  · The structural reason why a peanut-shaped face looks prominent
  · The limitations of cheekbone reduction alone
  · How Double Slim, Ultherapy, and Sculptra each serve a different role
  · Who this combination is best suited for

The Structural Reason Why the Peanut-Shaped Face Looks Prominent

The peanut-shaped face typically involves three overlapping features: cheekbones that flare outward, a slightly sunken temporal area above them, and hollowing in the posterior cheek area (the region just behind the cheekbones, near the ears). When the continuous curve from top to bottom is interrupted in the middle, the cheekbones end up standing out on their own.

In many cases, it's not that the cheekbones themselves are especially large — rather, the surrounding volume has been lost, making the cheekbones appear more prominent by contrast. This is why even after cheekbone reduction, the face can still look flat and wide from the front. The temples above and the posterior cheeks on the side need to be filled in for the cheekbones to blend naturally into the surrounding contour. If your side profile looks fine but front-facing photos always feel a little off, you're likely dealing with this type of structure.

The Limitations of Cheekbone Reduction Alone

Focusing solely on cheekbone reduction can leave one notable drawback. As the temporalis muscle* alongside the cheekbones also reduces in volume, the temporal hollowing above can appear even more pronounced. This is why some patients notice that after a reduction procedure, the cheeks look narrower but the upper face looks more sunken — giving an overall tired impression.

Temporalis muscle*: This is the chewing muscle located above the temples. When Botox is used to reduce its volume, the width of the temporal area narrows — which can make the upper face look more hollow, which is why volumizing is often considered alongside reduction.

Conversely, focusing only on volumizing will fill in the temples and posterior cheeks, but the cheekbones will still flare outward — so the front view remains wide. You gain dimension, but the broad frontal appearance stays. This is why a setup that reduces the cheekbone area while filling the temples and posterior cheeks — addressing both directions together — tends to produce the most natural outcome. Botox works by blocking the release of acetylcholine at the neuromuscular junction, relaxing the targeted muscles, and is used to reduce the volume of the temporalis and zygomaticus muscles.

How Double Slim, Ultherapy, and Sculptra Each Play a Different Role

All three procedures fall under facial contouring, but each serves a distinct purpose. Double Slim and cheekbone Ultherapy focus on reduction, while Sculptra focuses on volumizing. The table below breaks down the differences at a glance.

Procedure	Primary Role	Best For	What to Expect During Recovery
Double Slim (Cheekbone + Temporalis Botox)	Reducing muscle volume	Prominent cheekbone and temporalis muscles	Minor Bruise at injection site, usually resolves within a day
Cheekbone Ultherapy	Lifting sagging tissue below the cheekbones	Sagging or drooping below the cheekbones	Mild Swelling immediately after; minimal disruption to daily activities
Sculptra	Restoring Collagen to hollow areas	Hollow temples and posterior cheeks	Injection sites may appear swollen for a few days

Double Slim is a dual-approach Botox procedure targeting both the zygomaticus and temporalis muscles. Rather than reducing just the cheekbones, it also addresses the temporalis to refine the upper facial contour. Cheekbone Ultherapy is not a bone-shaving procedure. It uses focused ultrasound energy to stimulate and lift the sagging SMAS Layer* beneath the cheekbones. Since focused ultrasound induces remodeling of Collagen and elastin fibers within the skin, results appear gradually over weeks to months rather than immediately.

SMAS Layer*: The superficial musculoaponeurotic system. This fascial layer sits approximately 4.5mm beneath the skin's surface and is the primary target layer where Ultherapy concentrates its ultrasound energy.

Sculptra is a Collagen booster containing poly-L-lactic acid* (PLLA) that gradually stimulates the body's own Collagen production from within. It restores dimension to hollow areas such as the temples and posterior cheeks. This ingredient is classified as a bioresorbable, semi-permanent injectable that restores volume and progressively stimulates Collagen formation.

Poly-L-lactic acid*: Also known as PLLA. It is a biodegradable synthetic compound that breaks down within the Dermis while stimulating Collagen production. It is the active ingredient in Collagen boosters such as Sculptra.

Each of the three procedures delivers results on a different timeline. Botox works relatively quickly, while Ultherapy and Sculptra show gradual improvement over several months as Collagen builds up. The diagram below illustrates, for reference, how the combined effect of all three procedures contributes to a softer, more defined contour over time.

Who This Combination Is Best Suited For

This combination tends to work well for those with outward-flaring cheekbones alongside hollow temples and posterior cheeks. On the other hand, a different approach may be more appropriate in the following cases:

• Significant bony cheekbone protrusion — When the bone itself is the primary issue, injectables and non-surgical procedures alone may have limited effect, and osteotomy surgery may be a more appropriate option.
• A fuller face where volumizing isn't necessary — A different approach may be more suitable if there's no significant hollowing to address.
• Pregnancy, breastfeeding, keloid-prone skin, or active inflammation — It's important to consult with a medical professional first to determine whether any procedures are appropriate.

There are also three key points worth discussing during your consultation: the amount of Double Slim needed is determined by temporalis muscle thickness; the volume of Sculptra required varies depending on whether only the temples or also the posterior cheeks will be treated; and if you have an upcoming event such as a wedding, it's advisable to allow enough time for any Swelling to fully subside before scheduling your procedures.

How Beautystone Clinic in Hongdae Approaches the Peanut-Shaped Face

The peanut-shaped face rarely resolves with a single procedure. Achieving a natural result typically requires balancing both reduction and volumizing in concert. At Beautystone Clinic in Hongdae, rather than focusing on the cheekbones in isolation, our approach prioritizes a comprehensive assessment of the full three-dimensional structure of the face — including the temples and posterior cheeks — before determining which combination is right for you. A board-certified dermatologist personally evaluates the temporalis muscle thickness and the degree of hollowing, then maps out the appropriate ratio of reduction to volumizing. The clinic is also within walking distance of Hapjeong Station, making follow-up visits convenient as you progress through your recovery.

Frequently Asked Questions

Q. Can all three procedures be done on the same day?

A. In most cases, yes — all three can be performed in a single visit. The typical sequence is Double Slim first to relax the muscles, followed by Ultherapy to lift the tissue below the cheekbones, and finally Sculptra to fill the temples and posterior cheeks. Downtime is generally minimal, and most patients are able to return to their daily routine the following day. That said, depending on your skin condition, it may be advisable to spread the procedures across separate visits — which is something we determine together during your consultation.

Q. When will I start to see results?

A. The timeline varies by procedure. With Botox (Double Slim), the muscles relax and cheekbone width visibly narrows within about 1–2 weeks. Ultherapy results appear gradually over 2–3 months as Collagen regeneration progresses, and Sculptra also fills in over a period of 1–3 months. The point at which all three effects converge — around 2–3 months — is typically when the most noticeable change becomes apparent. Individual results may vary.

Q. My cheekbones are fairly large — can this combination reduce them significantly?

A. If the cheekbones are significantly protruding at the bone level, non-surgical injectables and procedures alone have their limits. This combination is designed to address muscle volume, sagging, and surrounding hollowing — not to alter the underlying bone structure itself. If bony protrusion is your primary concern, it may be worth discussing with your doctor whether osteotomy surgery is a more suitable option.

Q. How many vials of Sculptra will I need?

A. It depends on the area being treated. The amount required differs based on whether only the temples are being addressed or the posterior cheeks are included as well. In some cases, rather than determining the full volume in a single session, it's preferable to assess the degree of hollowing and fill in stages. The precise dosage should always be determined by a medical professional who has directly evaluated your face.

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