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Dr. Barry Eppley

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Posts Tagged ‘midface implants’

Contemporary Cheek Implant Options

Tuesday, March 11th, 2014


Of all the potential areas of facial skeletal augmentation, cheek implants are the second most commonly performed location. Having noticeable and strong cheek bones is considered just about part of every aesthetically pleasing face, There are gender and other ‘look’ differences in the dimensions of the cheek prominences but their presence is a key aesthetic element of an attractive and proportionate face.

Unlike the chin or the nose, the cheeks represent a paired area of facial bone prominences and this accounts for some of the unique considerations when surgically enhancing them. The cheek implants must not only be symmetrically placed but must have the right shape and size to give the cheeks their desired look.

While cheek implants used to be thought as two oblong shapes that were positioned right over the front edge of the zygomas (cheeks), that original approach was just the first step in how far cheek augmentation has come today. Understanding the different shapes of contemporary cheek implants can create a cheek look that best suits their face. They fundamentally break down into three types based on what area of the cheek they augment.

Malar Shell Cheek Implants Dr Barry Eppley IndianapolisThe traditional cheek implant is now described as a Malar Shell. It is called that because it sits over the curved zygoma and augments it in a near 120 degree arc. It most closely mimics the natural shape of one’s zygoma and just makes it bigger. For people with flat cheekbones from the lateral infraorbital rim down, particularly those who have a negative vector, this implant produces a natural and not overly prominent effect.

Submalar Cheek Implant Dr Barry Eppley IndianapolisIn the mid-1990s, the submalar implant was a revolutionary improvement in the few cheek implant styles that were available. It is designed to sit on the lower half of the cheek bone, creating more fullness below the cheekbone prominence and helping to pick up any sagging cheek tissues. It was even touted as a volumetric midface lift. It creates that effect in the patient with midface aging as well as one who has submalar hollowing from facial lipoatrophy.

Combined Submalar Shell Cheek Implant Dr Barry Eppley IndianapolisFor those patients who are in need of a more total cheek augmentation effect combining the malar and submalar areas, there is the Submalar Shell implant which can also be called the Midface Implant. Putting the two together gives a combined bone augmentation to the cheek prominence and a volumetric fill to the area below…a combined bone and soft tissue effect.

Midface Implant Dr Barry Eppley IndianapolisGoretex-Coated Cheek Implants Dr Barry Eppley IndianapolisWhile not a different style, several features have been added to these cheek implant shapes that help them adapt to the bone better and provide increased soft tissue fixation. The Conform feature is that implant is no longer a solid piece but has a grid pattern on its backside that allows the ultimate in adaptability to the bone.  (increased flexibility) The addition of a 0.3mm layer of Gore-Tex on the outside of the silicone implant provides a semi-porous outer layer for soft tissue to quickly grow into and fix the implant in position. (if a screw is not being used)

Selecting the cheek zones to augment is the key in selecting the proper cheek implant style. Selecting the right size of implant, however, is more of an art than an exact science as there is no quantitative measurement to make that determination. But in general it is usually better to be more conservative (smaller) than one would think as these broader surface area cheek implants of today can create a bigger effect than one might think when just holding them in your hand.

Dr. Barry Eppley

Indianapolis, Indiana

Understanding the Zones of Midface Implants

Monday, June 14th, 2010

Facial implants have come a long way in the past two decades with the introduction of dozens of different styles. One of the expanding facial implant areas is that of the midface. Known commonly as the cheek, it has become recognized that its anatomy is more complex than a single implant design can adequately treat. With the numerous midface implants now available, more patients than ever are being implanted. With increasing numbers of midface augmentations comes complications. The vast majority of these complications are cosmetic in nature, meaning the final result was not what the patient had hoped.

Undesired midface implant results are usually the result of a mismatch between the patient’s aesthetic concerns and the implant type and size. The large number of implant options may seem confusing, but midface augmentation can be thought of as three zones or implant locations. These include the malar, submalar, and suborbital tear trough malar regions. There are more anatomic zones to the midface, but based on desireable facial changes, these three areas can be effectively enhanced.

The malar area is the most midface zone enhanced and makes up the major aspect of the zygomatic or malar bone. This extends from the infraorbital nerve to the middle third of the zygomatic arch. Malar implants create a high, strong cheekbone which is for men who want a more sculpted facial appearance or by younger women who want more of an exotic look.

The submalar area lies below the zygomatic bone. It actually sits on the top portion of the masseter muscle where it comes up and attaches to the underside of the zygomatic bone. This facial area has become recognized as significant because fat is lost in this area with aging. Submalar hollowing can also be created in the younger person with a fuller face by buccal fat pad removal. Augmenting the submalar area can help reestablish a more youthful appearance by building it out again. When introduced over a decade ago, the submalar implant was touted as a substitute for a midface lift by being able to lift up sagging cheek tissues. This probably overstates the effect that it actually does create.

The newest midface zone to be effectively implanted is the suborbital tear trough area. Extending from the medial canthus, over the top of the infraorbital nerve, and along the lateral orbital rim extending into the malar area, this implant fills out suborbital flattening and tear trough depressions. Because of its location, this implant must be inserted from a different direction than all midfacial implants…from above (through the eyelid) rather than from below. (through the mouth)

While these three types of midfacial implants augment areas in close proximity, their effects can produce dramatically different facial changes. Subtle changes in the midface are easily detectable because of their proximity to the eye, a visual focal point in all conversations. The rise in the number of midfacial implants has led to, not surprisingly, an increased rate of complications. Many times the correct zone is augmented but the implant is too big. It is always best to undersize a midfacial implant in most cases. Unless there is a significant facial bone deficiency (e.g., maxillary hypoplasia), large midfacial implants should not be used. What make look like a significant improvement on the operating table can look dramatic in real life afterwards. Other times, the effect the implant created was different than the patient expected. This is most commonly seen with the submalar implant when it is used for a cheek tissue lifting effect and all the patient sees afterwards is unnatural fullness.

The three primary midfacial implants add an effective arsenal to a variety of congenital and age-related midfacial changes. Complications can be avoided by an implant size and type that is suited to the patient’s aesthetic concern. While the midface is one of the hardest facial areas to accurately computer image, such analysis furthers the dialogue between patient and plastic surgeon.  

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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