While cheek augmentation can be done by synthetic injectable fillers or fat injections, the only assured permanent method is through the use of preformed implants. Cheek implants come in a variety of styles and sizes and it is critical to make these implant choices thoughtfully to get the desired midface result. The most common aesthetic cheek implant complication, however, is that of asymmetry.
Cheek implants are the second most commonly performed facial implant used behind those used for the chin. But unlike chin implants, cheek augmentation requires the use of two implants that must be placed with their symmetry in mind. But cheek implantation sites can be difficult to see simultaneously and their symmetry is usually assessed by external evaluation of how the cheeks look. But swelling and other tissue distortions can mar the accuracy of this comparative assessment. This external view is complemented by also assessing how the implants rest on the bone between the two sides.
But despite the best placement efforts, cheek implant asymmetry can occur. This could be due to initial asymmetric implant placement or a migration/shift of the implant afterwards. Due to the size of the implant pocket initially, unsecured cheek implants can shift move right after surgery. (early displacement) It is very rare to have a cheek implant change position months or years later (late displacement) although it can happen. Why a cheek implant would have such a delayed shift in position long after the enveloping capsule (scar) around it has been created and healed could be infection or a reactive seroma formation. Surgery performed near the implant can also cause an implant reaction and subsequent shift. (picture shows a CT scan with cheek implants at two different positions and a reactive fluid collection around the left cheek implant as it moves its way towards the mouth incision)
Cheek implant reposition surgery can be performed but is rarely as simple as just ‘moving the implant around’. Because scar tissue forms around all synthetic materials, repositioning of implants usually requires some form of capsulectomy/capsulotomy. (releasing or excising portions of the existing implant’s pocket) In addition, it is critically important to secure the cheek implant into the new position and this is most reliably done by screw fixation with self-tapping titanium 1.5mm microscrews. A layered closure over the implant consisting of muscle and mucosa is also important to keep as much soft tissue between the intraoral cavity and the implant pocket.
Because of the path of cheek implant insertion, asymmetry or migration of the implant is usually downward towards the location of the incision. This occurs also because the cheek bone is sloped downward and the maxillary bone underneath it is concave, making movement in that direction easy. Thus , most cheek implant repositioning is moving the implant back up over the bone.
Dr. Barry Eppley
Indianapolis, Indiana