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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Archive for the ‘cheek implant’ Category

The Extended Cheek-Arch Implant

Sunday, January 21st, 2018


Permanent aesthetic augmentation of the midface is done by cheek implants. While there are other areas in the midface that can be augmented, the cheeks are done the most frequently. A variety of standard preformed styles have evolved over the years that largely provide differing amounts of augmentation over the main body of the zygoma. There is some coverage of the posterosuperior maxilla and the front part of the zygomatic arch but this is more for a feathering of the implant edges.

But like all fashion styles they evolve over time. This is no different for the aesthetics of cheeks. Desirable midface looks today often show cheek highlights that sweep back over the zygomatic arch. Models show varying locations of malar and submalar augmentations but the sweep back over the whole length of the zygomatic arch remains the same. This is a look that can not be obtained by any standard form of cheek implant.

This more dramatic cheek augmentation look requires an implant that extends back over the whole length of the zygomatic arch and can be called the malar-arch style or the extended cheek implant. This implant starts further down on the maxilla and creates a sweep of material far back along the arch almost to the ear. That is a much different implant design compared to standard cheek implants and is actually a more anatomic design as it covers the cheek or zygomatic-maxillary complex more completely.

There may be some subtle differences between men and women for the extended cheek-arch implant design. Men may want less fullness in the anterior aubmalar cheek area in effort to have more of a hollowed or ‘chiseled’ appearance if their soft tissues will permit it. But the implant sweep back across the zygomatic arch remains important.

The extended cheek-arch implant is still placed through an intraoral incisional approach. The zygomatic arch must be done carefully to keep the dissection on the thin arch. It must also be done completely subperiosteal to avoid injury to the frontal branch of the facial nerve as it crosses over the posterior arch up into the temples.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Cheek Implant Seroma

Sunday, January 21st, 2018


Background: A seroma is a well known postsurgical phenomenon that every surgeon from every discipline has seen and treated. This fluid collection typically occurs when a pocket has been created in surgery for access or implant placement. It is the creation of a pocket or dead space as it is often called that provides a place for the fluid to collect. While typically absorbed in small amounts, large outputs of serous fluid overwhelm the body’s ability to absorb it. Such seromas may then necessitate removal to avoid a culture medium for infection or relieve symptoms of pain caused by fluid distention and external contour deformity.

Seroma fluid is principally plasma from the blood that leaks out of small cut blood vessels. It is also mixed with inflammatory fluid from injured cells. Despite knowing what serum fluid is and how it is created, there is much about its causes and treatment that even today is still not well understood. In plastic surgery the development of symptomatic seromas are most well known in tummy tuck and breast reconstructive surgery. While one involves an implant and the other doesn’t the large dead space is the culprit and method to make the dead space smaller, such as drains or quilting sutures, are employed to prevent the development of a serum.

Seromas in the face are very uncommon despite large skin flaps being raised (e.g., facelift) or the use of synthetic implants placed all over the face. The small size of the face, its superior location for downhill drainage and its superb blood supply may alb reasons that facial serums are rarely seen particularly around facial implants.

Case Study: This young female has a history of elective primary cheek augmentation with implants four months previously placed through an intraoral approach. Due to an undesired facial effect she was taken back to surgery for the replacement of her implants with new cheek implants of a different style. (large male shells according to the patient) When the swelling resolved she was pleased with the aesthetic outcome.

One month after the cheek implant replacement surgery, she bumped the right side of her face and the cheek implant area swelled. After a few days it stabilized but remained the same over the past six weeks. Her cheek area was marked swollen, but not red, was dramatically different ins she and shape from the other side, was tender to the touch and radiated pain up into the temporal area.

The lack of any facial redness and a well healed intraoral incision with no drainage make the diagnosis of a serum likely. Through an anesthetized intraoral approach, an 18 gauge was inserted into the implant space from which 3.5cc of a serosanguinous fluid was extracted. Her right cheek immediately deflated to match the her left side and provided a relief of her uncomfortable symtoms.

Why a seroma develops from the capsule (scar) tissue that surrounds a facial implant, either early after the initial surgery or years later, is an interesting question. The capsule is a form of healed scar tissue that develops as a normal bodily response to any implant material. Borrowing from what is well known in breast implant capsules, it is a collagen fiber layer who under microscopic examination have cytoplasmic processes at the surface layer. These long cytoplasmic processes contain vacuoles ultrastructurally which have phagocytic capabilities. The extracellular matrix of the surface layer is an amorphous immature fibrillar protein. This demonstrates that the capsule is far from a static collagen layer and events like trauma or infection can lead to an egress of serous fluid.

Will this lady’s cheek implant seroma be resolved by a single aspiration? This remains to be seen. If not surgical intervention will be required.


1) Cheek implants vary rarely can develop a seroma.

2) Trauma and infection of a cheek implant can induce the capsular lining to leak serous fluid.

3) The initial treatment for a confirmed or suspected cheek implant serum is needle aspiration.

Dr. Barry Eppley

Indianapolis, Indiana

The Model Cheek Implant (Malar-Arch Design) for the High Cheekbone Look

Thursday, June 22nd, 2017


Cheek implants have been around for decades and have undergone an evolution of design changes. While initially developed as small oblong shapes to sit on top of the malar eminence, newer designs have incorporated the area under the malar eminence as well known as the submalar region. This has led to a variety of current shapes that include malar, submalar and combined malar-submalar (shell) styles, creating up to five different cheek implant options. (not to mention the various sizes of each style)

But careful analysis of the actual anatomy of the zygomatic complex (aka cheekbone) reveals that it does not match the shape of any current cheek implant. Structurally the cheekbone is fairly complex with a main body and three processes that articulate with other bones (frontal, temporal and maxillary) and has four borders. When the term ‘high cheekbones’ is used from an attractive and desirous facial beauty standpoint, this usually refers to more pronounced zygomatic arches or its posterior process. This causes a raised line along the sides of the face to appear which creates a distinct facial skeletal feature. This is often seen in fashion models in both men and women.

No performed cheek implant today truly creates the ‘model cheek’ look as they do not incorporate the zygomatic arch process as part of their design. To achieve this effect a special designed cheek implant is needed.  It can have various anterior shapes but the key element in the extended posterior zygomatic arch process. This extension can go back all the way to the temporal region if desired. Besides creating the raised line back from the cheek it also creates a smoother and more blended flow up across the cheeks  and back along the face rather than just a raised ‘bump’ over the cheekbone.

This malar-arch cheek implant design is placed in the standard intraoral fashion through the mouth. Subperiosteal dissection is carried way back along the zygomatic arch. As long as one is right on the bone there is no danger of injury to the frontal branch of the facial nerve that crosses in the tissues above the posterior zygomatic arch. The length of the tail of the implant can be shortened based on the patient’s anatomy and aesthetic goals. Because the implant has a long surface area contact with the bone in a more horizontal orientation the risks of intraoperative implant malposition and postoperative migration (if screw fixation is not used) is greatly reduced.

The model cheek implant is a malar-arch design that adds a skeletal coverage area not previously seen in any previous midface implant. It creates the high cheekbone look that many younger patients today seek in with contemporary fashion and beauty trends.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Cheek Implant Asymmetry Correction

Saturday, May 20th, 2017


Background: Augmentation of the cheeks is a frequently performed aesthetic facial reshaping procedure. While once only capable of being performed with implants, it is now more commonly done with synthetic fillers and fat. But the only assured permanent cheek augmentation result from a single effort is with the use of implants.

Like all implants placed anywhere in the body, cheek implants have the traditional medical risks of infection. Fortunately this is very low even though the intraoral route is a common incisional method of insertion. The most common risks with their use is aesthetic with an undesired outcome due to implant style, size or positioning on the bone.

In my experience cheek implant asymmetry is its most common aesthetic risk. This is a risk that is shared by any facial implant in which it is bilateral. (has a right and left side) While not commonly appreciated it is very difficult to get perfect facial implant symmetry when they have to be placed in pairs. There are a variety of reasons why implant asymmetry occurs but the fundamental reason is that the limited incisions do not allow for bilateral implant positioning assessment by direct vision.

Case Study: This 35 year male had cheek implants placed five years ago to improve flatter cheeks. He knew right after surgery that the implants were asymmetric and it had always bothered him since. He liked the right side but felt the left side was flatter. He finally decided to seek a solution and a 3D CT scan showed that the left implant was more anteriorly positioned and its shape was different from the right side.

Under general anesthesia and through his existing left maxillary vestibular scar, the left cheek implant was located. It was above the periosteum in a more superficial location and close to the infraorbital nerve. On its removal it could be seen that it had been modified in an irregular fashion. The purpose of the implant modification was unclear. The cheek implant was reshaped to a smoother upper contour and re-inserted and positioned as per the right side of the 3D CT scan. Double screw fixation was used through the implant to ensure its new position on the bone.

In comparing the implant with the preoperative 3D CT scan, it could be appreciated how accurate the scan was in both identifying the implant shape and its anatomic position in the patient. In addition without an exact knowledge of how the right cheek implant was positioned, it would have been impossible with any accuracy to know what the matched position was to the opposite ‘good’ side.


  1. Cheek implant asymmetry is common regardless of implant style and size.
  2. A 3D CT scan is essential when considering cheek implant asymmetry correction.
  3. Repositioning of one or both cheek implants is guided by the the 3D CT scan of the good side.

Dr. Barry Eppley

Indianapolis, Indiana

Profileplasty by Rhinoplasty and Sliding Genioplasty

Saturday, July 13th, 2013


While one does not see their face in a profile view naturally (only in pictures), the world sees your face in three-quarter view or in profile. Thus the perception of one’s own facial profile is important and it is stressed in many plastic surgery procedures. The two most important hard structures that make up the profile is the nose and the chin. As such the combination of a rhinoplasty and genioplasty is often done together. When done simultaneously, this combination has even been called a profileplasty.

These two profile structures influence each other even if only one is surgically changed. It is well acknowledged that reducing a large nose makes the chin look bigger and chin augmentation can make the nose look smaller. Certainly it can be a very powerful profile changer when a larger nose and a smaller chin are simultaneously corrected.

While a reduction rhinoplasty can be done by various methods based on the actual deformity, these represent relatively minor technical differences in the manipulation of the bone and cartilages. In contrast, a genioplasty can be done by fundamentally different techniques…an implant or an osteotomy. (sliding genioplasty) There are advantages and disadvantages to either type of genioplasty but most patients undergo the ‘simpler’ implant augmentation. Only a minority of chin augmentations are done by a sliding genioplasty although this is often the common chin augmentation technique for oral and maxillofacial surgeons.

Long-term outcomes of combined rhinoplasty and genioplasty patients are rarely reported probably because most plastic surgeons correctly assume that patients are very happy and there is little to gain by looking at the long-term results. But no studies to my knowledge have ever been reported looking at combined rhinoplasty and sliding genioplasty augmentation.

In the July 2013 issue of the Archives of Facial Plastic Surgery, a study was published entitled ‘Combined Rhinoplasty and Genioplasty: Long-term Follow-up’. In this paper, a total of 90 cases of combined open rhinoplasty and augmentation/reduction genioplasty over a three year period were reviewed to assess the stability of the aesthetic results. Specifically the chin was studied by anthropometric measurements. Soft tissue pogonion projection to the true vertical line and mandibular height (incisor to menton) were measured. The average horizontal augmentation genioplasty had 7mms advancement and the average vertical lengthening genioplasty had 5mms increased height. The measurements shows a 100% stability after three years. In reduction genioplasty, half of the patients had 100% stability after three years. The results of this study showed that there is minimal change (less than 1mm) in the chin position as part of a profileplasty.

While rhinoplasty and genioplasty is common, doing the genioplasty portion by a sliding osteotomy rather than an implant is very uncommon. The only advantage that a bony genioplasty has over an implant in most typical aesthetic patients is when a vertical chin change is needed. Given the average amount of horizontal advancement in this study that movement alone is well within the range of what an implant can do. The stability of the bony movements of a sliding genioplasty has been extensively studied before without being done at the same time as a rhinoplasty. This study corroborates what many studies have shown before, bony chin changes are fairly stable and any relapse or bone resorption is not clinically observable or significant.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Sliding Genioplasty with Implant Overlay for Chin Implant Replacement

Saturday, July 6th, 2013


Background:  Chin augmentation is the most common implant enhancement procedure of the face. It is usually highly successful as long as the chin is not horizontally too short. Once horizontal chin deficiences approach 10mms or more, it will also have other dimensional issues as well being also vertically short.Trying to make a chin implant correct an overall short chin will leave the patient with a suboptimal result.

Once a chin implant augmentation procedure is deemed inadequate, one has to consider whether a new implant or a sliding genioplasty would be better. With greater than a 10mm horizontal deficiency, only a custom computer-designed implant will suffice. Besides that no existing commercially-made chin implants do not exceed 11mms, none provide any vertical lengthening at all. The other option is a sliding genioplasty. The downfractured chin segment can be moved as far forward as the thickness of the chin bone which almost always is more than 10mms. The other benefit that a sliding genioplasty provides is that the chin can be vertically lengthened by opening up the chin segment as it is brought forward.

While a sliding genioplasty can provide significant horizontal and vertical chin changes, it is not always a perfect chin augmentation procedure either. The amount of horizontal projection increase can not exceed the thickness of the chin bone so very short chins may still be left aesthetically deficient. In addition as the u-shaped chin segment is brought forward, the chin shape will actually become more narrow as the projection is increased. This may be an aesthetic disadvantage for some men who prefer or desire a more square or wider chin appearance in the frontal view.

Case Study: This 50 year-old male wanted to make one final effort at improving his chin shape. He had a prior history of two chin augmentation procedures using implants. He originally had an original 7mm anatomic silicone chin implant that was subsequently replaced by a 9mm Medpor two-piece chin implant that had been separated in the middle to give more of a square chin look. While he was improved with each procedure, he felt his chin was still too short. In addition, his chin felt tight and mildly uncomfortable even years after the second procedure.

Under general anesthesia, an intraoral anterior mandibular incision was made. The indwelling Medpor implant was exposed, unscrewed and removed. Contrary to popular perception the Medpor material did not have any bone ingrowth and, although the surrounding tissues were adherent, was not unduly difficult to remove. A horizontal chin osteotomy (sliding genioplasty) was done with the back end just beyond where the tails of the removed implant were. The downfractured chin segment was brought forward 12mms and secured into placed with a titanium step plate and two screws above and below the osteotomy line. To make the chin have more width, a small square silicone chin implant was placed in front of the chin segment and secured to it with screws. The mentalis muscle was then resuspended over the implant and advanced bone in layers.

His recovery showed the typical swelling and bruising down into the neck that commonly occurs with sliding genioplasties. It took almost three weeks until all swelling and bruising had resolved.

Significant chin deficiencies that do not achieve good results with implants may achieve better results with a sliding genioplasty, particularly when a vertical chin deficiency exists. Contrary to common perception, an implant can be used in front of a sliding genioplasty if more horizontal projection or greater width is needed.

Case Highlights:

1) Once a horizontal chin deficiency exceeds 10mms, standard chin implants will not produce an ideal result.

2) A sliding genioplasty can almost always extend the chin further forward than an implant.

3) To overcome the round chin shape that will occur from a sliding genioplasty, a square chin implant can be overlaid in front of the advanced chin segment.

Dr. Barry Eppley

Indianapolis, Indiana

The Uniqueness of Male Plastic Surgery – Facial Procedures

Saturday, June 15th, 2013


The facial aging process is one that is well known as everyone will eventually see it on their face. The eyes get heavy, the brows descend, the cheek fall, jowls develop and the neck sags. Women become concerned earlier in the aging process and proceed to do procedures to treat or slow it down in an overall more comprehensive manner. Men take a much more delayed approach to it often waiting until one facial area becomes a major concern or until the facial aging process is fairly advanced.

While the face ages largely similar in both men and women, the facial procedures used to treat them are often done differently. Not as many men have facelifts as their aging neck and jowls are more tolerated. But in men that have facelifts they must be done very carefully, respecting the natural hairlines of the temples and behind the ears and being careful not to displace the beard skin into the ear canal. Incisions must be placed very inconspicously and often less of a tightening result must be accepted to keep the scars hidden. That is not a bad thing as men look better underdone than having their faces pulled too tight anyway.

While men also develop heavy upper eyelid skin and lower eyelid bags just like women, their eyelid lifts (blepharoplasties) need to be done more conservatively. Browlift options in men are more limited due to the frequent lack of adequate scalp hair and a well defined frontal hairline. The most common male browlift method is through the upper eyelid (transpalpebral browlift) using the endotine device to accomplish the lift. This produces a very modest browlift but creates no visible scars and with more conservative eyelid skin and fat removals can avoid overfeminizing the male face and creating an unnatural overdone look.

Men do not engage in as many Botox and injectable fillers treatments as women as some wrinkles and signs of aging are more tolerated. A more natural result for men is one that reduces the worst of the wrinkles but does not eliminate all of them. This is the same reason men, at best, will only do a bare minimum of facial skin care. Many men would rather seek more definitive surgical procedures, or do nothing at all, that engage in non-surgical procedures that require frequent efforts to maintain.

Facial reshaping surgery is vastly different in men than women. Male rhinoplasties must keep a high and straight dorsal line and avoid an overly upturned tip while most women desire a smaller less projecting tip and lower dorsal lines. The shape of the face in men is dominated by a strong jaw and requests for chin, jaw angle and even total jawline enhancements are not uncommon to pursue a more masculine appearance and even the so called ‘male model’ look. Men favor higher more angular cheek augmentations while women prefer a lower more anterior rounded cheek prominence. Men pursue brow bone surgery for either reduction of an overlying prominent one or for augmentation to create a more masculine brow prominence and a more backward sloping forehead profile.

Plastic surgery for men has its own unique requirements both in the type of surgeries and the demeanor of the patients. One should not assume that every plastic surgeon or plastic surgery practice is equally adept about meeting the needs of the male patient. Just like breast reconstruction for women or body contouring after massive weight loss, the male patient presents unique challenges for a satisfying surgical outcome.

Dr. Barry Eppley

Indianapolis, Indiana

The Importance of Skeletal Support in Midface Lifts

Monday, May 13th, 2013


Rejuvenation of the aging face has well established methods for correcting the upper (browlift) and lower face (lower facelift/necklift) that produces consistent and satisfying results. But the face does not age in just individual subunits and the midface has similar aging issues that are uniquely different. Sagging cheeks, lower eyelid hollowness and lines and folds under the eyes present challenges for successful rejuvenation.

The development of midface rejuvenation techniques has historically lagged behind that of the upper and lower face. Only in the past decade has the concept of midface lifting emerged. The vector of the midface lift is different than that of a facelift being more vertical than oblique in orientation and more closely resembles the direction of a browlift. But it has been associated with significantly more complications and dissatisfaction than either browlifts or facelifts.

The factors that contribute to midface rejuvenation complications are several fold. First, most midface lifting techniques go through the lower eyelid and require resuspension after the tissues are lifted. This places the lower eyelid at risk for sagging or ectropion due to the tension placed on it and the very delicate suspension system of the lower eyelid which is easily disrupted. Secondly, where to attach the lifted cheek tissues to is limited and adequate bony support may be lacking.

As a result of this midface conundrum, a wide variety of open and endoscopic midface lifting techniques has developed. There is no consistent midface rejuvenation technique and this has lead to a lot of confusion on the part of both surgeons and patients alike.

To aid surgeons in midface analysis and in the selection of the most successful rejuvenation strategy, a paper on this topic published in the March 2013 issue of the journal of Facial Plastic and Reconstructive Surgery. A retrospective review was done on 150 patients who had midface rejuvenation procedures done by a single surgeon. The procedures included cheek implants, fat injections, limited and full midface lifts and facelifts. The vast majority were women (93%) with an average age of 51 years as would be expected. About one-third of patients had more than one treatment for their midface aging. Patient dissatisfaction in this study was 14%. Fat grafting alone had the highest rate of dissatisfaction of all treatments. The rate of patient dissatisfaction was associated with malar hypoplasia (skeletal deficiency) and loss of skin elasticity.

What makes midface rejuvenation unique from a facelift is that the degree of skeletal support is significant. No matter how well the cheke tissues are lifted, failure to achieve an aesthetically pleasing or a sustained result is doomed if the cheek bone does not have adequate projection to support it. The use of cheek volumizing through implants is needed in such cases. When the cheek skin has poor elasticity, pulling up alone again is inadequate and adding skeletal support needs to be considered.

Dr. Barry Eppley

Indianapolis, Indiana

Surgical Facial Changes for the Male Model Look

Wednesday, August 3rd, 2011

Almost anyone in the world is aware of the recent tragedy in Norway with the mass killings of an incomprehensible number of Norwegian teens and young adults. The murderer Anders Breivik appears to have acted alone, driven by his white supremacist and anti-Muslin views. What has caught my attention as a plastic surgeon, however, is comments that have been written about his facial appearance.


According to the head of Norway’s intelligence agency, it is believed that he had undergone plastic surgery in the past to look more “Aryan.” The agency’s head has stated that “You do not have that Aryan look naturally in Norway”…”Hitler would have had him on posters. He has the perfect, classic Aryan face. He must have had a facelift.”


While I am not an expert on Norwegian facial structure, I do know that he would not have had a facelift to change his facial appearance. That is not what a facelift does. A facelift is what I call ‘anti-aging facial surgery’, where one is trying to return to one’s prior appearance. This does not change your face but rather makes it look rejuvenated and less tired like it did 10 or 15 years ago. But you still look like you, just a better you.


Rather he would have undergone ‘structural facial surgery’, where the foundational components of the face are altered. That can and often does change one’s appearance. Foundational facial procedures are done at the bone or cartilage level, not just the skin and soft tissues. This includes plastic surgery procedures such as rhinoplasty and facial bone augmentations. (forehead, brow, cheek, chins and jaw angles) According to reports, he supposedly underwent nose and chin surgery at age 21. This would make more sense as these can change the structure of the face and definitely can make one more Aryan in facial appearance, particularly if certain elements of the face are already there.


This raises the question of what is an Aryan facial appearance and why does it look so? The word Aryan, at least as it was perceived and used in Nazi Germany, specifically refers to being white, blond-haired and blue-eyed. But there is not necessarily a specific set or arrangement of facial features that are ascribed to an Aryan face. People talk about it and one would know if they saw it but may not be able to describe the details of it.  But what it undoubtably refers to is a strong and well-chiseled face. For a male this would be highlighted by well-defined facial bony prominences of the brows, cheeks, chin and jaw angles. The nose would have a strong and high dorsal line with a balanced ratio between the three nasal thirds.


The concept of an Aryan face continues to exist today but it is better known as the ‘Male Model Face’. Most young male models in any advertisement today almost all have this type of facial appearance. Whether they have it by genetics, plastic surgery or the use of good lighting and/or Photoshop, the strong and desireable male face has these consistent features.


Plastic surgery techniques today can help many men undergo these type of structural facial changes. Rhinoplasty, anatomical cheek implants, square chin implants, vertical lengthening jaw angle implants and occasionally select fat removal below the cheeks and in the neck can create a face that has more well-defined angles and is more masculine in appearance. For some men, this ‘Male Model Surgery’ can be very effective provided they don’t have a lot of facial fat and not an overly round face.  

Dr. Barry Eppley

Indianapolis, Indiana

Cheek Augmentation and Facial Attractiveness in Men and Women

Saturday, July 23rd, 2011

It is well known that one of the major contributors towards the perception of an attractive face, albeit a man or a woman, is the proportion of certain features. Known as indicators of facial beauty, disproportionate and asymmetric features are the main reasons many patients seek plastic surgery procedures. One can debate endlessly why this is so, but we are fundamentally driven to an attractive face from an innate drive of evolution and the desire to procreate. Attractiveness is desireable because it is perceived, right or wrong, to be associated with better genes.

But what are some of these features and can they really be changed by plastic surgery? For women it is bigger eyes, a rounder forehead, a smaller nose, well defined cheeks, larger lips and a chin that is not too prominent. For men, slightly prominent brows, a nose with a high dorsal line, well-defined cheeks, and a strong chin and jaw angles are associated with more masculinity. Short of the size of the eyes, all of these facial features can be modified by differing plastic surgery techniques.

The one desireable facial feature that both men and women share is the value of high and well-defined cheek bones. It is probably the only facial feature whose size and prominence is considered attractive for both sexes. It is also the one facial feature that I never receive requests to be reduced. (short of Asian patients and this more about the zygomatic arch width not anterior cheek projection) Few patients, if any, really want smaller cheeks.

What is it about high cheekbones that makes them some desireable? Many say that they feminize a face. If high cheek bones contribute to greater femininity, then why would it be attractive on men? The caveat is that it is only an aesthetically desireable facial feature in a man when it coexists with a stronger jawline as well. Strong cheekbones on a man with a small jaw or chin does not make for an attractive face. It is the angularity of the three defining points of a male face, the cheeks, chin and jaw angles, that makes for its aesthetic desireability. Such well-defined facial skeletal highlights equates with a strong and virile personal character. (and maybe the chance to pass along some good genes)

The benefits of cheek augmentation in either a man or a woman must take into consideration these aesthetic and gender differences. While cheek enhancement can be done with injectable fillers, I am reserving my comments here to the insertion of implants. Injectable fillers are largely a good trial method to determine the merits of proceeding to a permanent cheek augmentation in my opinion. Cheek implants in women should be softer and more round to provide volume but they usually don’t need to be angular or cross onto the zygomatic arch or encroach upon the lateral orbital rim area. This can add too much width which is not usually feminizing. Cheek implants in men often need to be more angular and add more height. They are beneficial to help balance out a strong jawline or should be done in conjunction with chin and jaw angle augmentation.

The cheeks can contribute significantly to one’s facial attractiveness. But it needs to be considered within the context of the whole face. The balance of one’s facial features is what makes for gender-specific facial beauty.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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