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Hollowing of the cheek after parotidectomy | CION Cancer Clinics
A hollow in front of the ear after a parotidectomy is the space the removed gland used to fill. In most cases it can be improved, either with your own tissue at the original operation or later with fat grafting or an injectable filler. Many people find it mild enough to leave alone once the swelling settles. This page explains why it happens, the options, when they are safe and what needs a review. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Can a hollow cheek after a parotidectomy be fixed?
- What can be done about the hollow?
- Filling it at the operation or filling it later?
- What does a fat-graft procedure involve?
- Four things families tell us, and what is actually true
- What this page cannot tell you
- Common questions about cheek hollowing after parotid surgery
The short answer
Can a hollow cheek after a parotidectomy be fixed?
Yes, in most cases it can be improved, either at the time of the operation or later. The hollow is there because the gland that used to fill the space in front of the ear has been removed. It can be filled at the original operation with your own tissue, or later with fat taken from elsewhere on your body or with an injectable filler. Many people find the dip mild enough to leave alone once the swelling settles.
Why the cheek dips
The parotid is a thick, wedge-shaped gland lying between the ear and the jaw. Removing part of it takes away some of that padding; removing all of it takes away more. The skin then sits closer to the muscle and bone beneath, which shows as a dip just in front of and below the ear. Thinner people notice it more, because there is less fat under the skin to soften the contour.
It looks worse before it looks better
In the first weeks the area is swollen, so the dip is hidden. As the swelling goes down the hollow appears, and it can seem to deepen for some months as the tissue settles. What you see at a year is close to the final shape. Decisions about filling it are made then, not in the early months.
Who it suits, and who it does not
Filling procedures suit people whose cancer follow-up is settled and who are troubled by the dip. They are usually not offered while radiotherapy is still planned or under way, or in the first year after a cancer, because a filled area is harder for the surgeon to examine. That is a safety choice, not a refusal.
The options
What can be done about the hollow?
Each has a place. Your surgeon will tell you which apply to your operation and your skin.
A tissue flap at the original operation
The surgeon folds a layer of your own tissue, from under the skin or from a neck muscle, into the space before closing. It fills the dip and also lowers the chance of sweating while eating later.
Does not suit
- Cases where that tissue is needed for a clear view of the tumour
- Some larger cancers, where the surgeon wants nothing between skin and bed
Fat grafting later
Fat is drawn from your abdomen or thigh through a small tube and injected into the hollow. Some of it is absorbed over the following months, so a second round is sometimes needed.
Skin that has had radiotherapy holds the fat less well. Ask what to expect if that applies to you.Injectable filler
A gel filler injected in the clinic, with no operation. The effect is temporary and is repeated. It is the least involved option and a reasonable way to see whether filling the dip is worth pursuing.
Does not suit
- Anyone still under active cancer surveillance of the area
- Skin that is thin, tight or recently irradiated
Leaving it alone
A real option, and the one most people take. The dip sits in a shadowed part of the face, hair and glasses soften it, and it bothers the person far less than they feared at the start.
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Filling it at the operation or filling it later?
At the original operation
Later, once healed
Uses your own nearby tissue, no extra procedure
Needs a separate visit or a small operation
Decided before you know how deep the dip will be
Decided once you can see the final shape
Also lowers the chance of sweating while eating
Does nothing for sweating while eating
May be ruled out by the tumour itself
Usually waits until cancer follow-up is settled
What to expect
What does a fat-graft procedure involve?
Assessment and photographs
The surgeon examines the hollow, checks the skin, confirms that cancer follow-up allows it, and takes photographs so you can compare afterwards. This is when to say what bothers you most.
Taking the fat
Under local or general anaesthetic, a small amount of fat is drawn from the abdomen or thigh through a fine tube. The donor area is bruised and tender for a couple of weeks.
Placing it
The prepared fat is injected in thin layers into the hollow through tiny punctures. The area is deliberately slightly over-filled, because some fat will be absorbed.
Settling and review
Swelling hides the result at first. The true shape shows over the following months, and a review then decides whether a second round is worthwhile.
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Commonly believed
Four things families tell us, and what is actually true
"The cheek is hollow, so the surgeon took out more than he needed to."
The hollow reflects how much gland had to go to clear the tumour with a safe rim of normal tissue around it. Leaving gland behind to keep the contour would risk leaving tumour behind. The pathology report, not the shape of the cheek, tells you whether the right amount was removed.
"A deepening hollow means the cancer is back."
The dip normally seems to deepen for some months as swelling goes and tissue settles. A tumour returning feels different: a firm lump you can press, growing, sometimes painful or with new facial weakness. Have any new lump checked, but a smooth dip on its own is expected.
"Fillers are permanent, so one session fixes it."
Injectable fillers are absorbed and need repeating. Fat grafts last longer, but part of the fat is absorbed too, so a second round is common. Nothing injected is truly permanent, and that is by design.
"Everyone ends up with a sunken face after this operation."
The degree varies enormously. After removal of only the outer part of the gland in a person with a fuller face, the change can be hard to spot. It is more noticeable after the whole gland is removed and in slim people.
!
One thing not to wait on: a new lump in the hollow
A soft, smooth dip is expected. A firm lump inside it that you can feel with a fingertip, especially one that is growing, painful, or comes with new weakness of the face, is not. Do not book a filler or wait for the next routine visit. Call your surgical team and ask for an early review, so it can be examined and, if needed, scanned.
Being straight with you
What this page cannot tell you
It cannot tell you how deep your own hollow will be, or whether it will bother you. Both depend on how much gland was removed, how your face is built, and how you feel about it once the swelling has gone, which is not something anyone can judge in the first months.
It cannot tell you what a centre offers
Not every centre does fat grafting or tissue flaps at the first operation, and the surgeon who removed the tumour may refer you to a plastic surgeon for later work. Ask your centre what they do, what they would recommend in your case, and when they would consider it safe.
It cannot tell you the cost
Filling a hollow after cancer surgery is sometimes treated as reconstruction and sometimes as cosmetic, and that decides what Aarogyasri, CGHS, ECHS, EHS or a cashless insurer will cover. Ask for a written estimate and ask the centre to check your cover before you commit to anything.
If you are unsure whether a change in the cheek is settling or new, call the helpline. Describing it, or sending a photo, is often enough to tell you whether to come in.Questions we are asked
Common questions about cheek hollowing after parotid surgery
Will the hollow fill in on its own?
Partly. The skin and the tissue under it settle and soften over the first year, and the sharp edge of the dip usually blurs. The volume that was removed does not grow back, so a hollow that is clearly visible at a year is roughly what stays unless it is filled.
How soon after surgery can it be filled?
Not before the shape has settled, which takes most of a year, and not while the area still needs close checking for the tumour coming back. Your surgeon sets that timing. If a flap was placed at the original operation, there is nothing to wait for.
Is fat grafting safe after cancer surgery?
It is widely used in reconstruction after cancer operations. The main caution is timing: surgeons prefer to wait until follow-up is settled, because filled tissue is harder to examine and scan. Radiotherapy-treated skin also holds the graft less well. Ask your own team what applies to you.
Can the surgeon prevent the hollow in the first place?
Often they can reduce it, by folding nearby tissue into the space before closing. It is not done in every case, because the tumour sometimes rules it out. If you have not had the operation yet, ask whether a flap is planned and what it would mean.
Will the hollow be worse after a total parotidectomy?
Usually yes, because more gland is removed. A superficial operation takes the outer part only and leaves the deeper part as padding. A total operation removes both. This is one reason surgeons remove only what the tumour requires.
Does the hollow affect eating or speech?
No. It is a change in shape, not in function. The muscles that chew and the nerve that moves the face are separate from the space the gland left. If eating or speech has changed, the cause is elsewhere and should be raised with your surgeon.
Are fillers done at a cancer centre or a cosmetic clinic?
Start with the surgeon who did the operation. They know what was removed and what follow-up the area needs, and they can refer you to a plastic surgeon who works with cancer patients. A cosmetic clinic that does not know your history may fill an area that should still be watched.
My father is not bothered but we are. What should we do?
Let him decide. A hollow cheek after a cancer operation is not a problem that needs solving unless it troubles the person who has it. Many people see it as the mark of something dealt with. Raise it once, gently, and leave the choice with him.
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Sources
- American Cancer Society — Surgery for salivary gland cancer
- Cancer Research UK — Surgery for salivary gland cancer
- National Cancer Institute — Salivary gland cancer treatment (PDQ)
- Macmillan Cancer Support — Salivary gland cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Superficial vs total parotidectomyHow much gland goes, and why that sets the hollowFrey syndrome: sweating while eatingThe other problem a tissue flap helps withThe scar in front of the earThe line that runs beside the hollowRecovery after parotidectomyWhen swelling settles and the shape showsCost, insurance and schemes for cancer surgeryWhat schemes cover and how to check
Talk to us
Unsure whether a change in the cheek is settling or new?
Describe it to us or send a photo. A surgical oncologist will tell you whether it needs a review and arrange one. One helpline serves every CION centre.