Cheek augmentation is a common facial reshaping procedure that is done for both aesthetic enhancement and volume restoration due to aging. It is the one facial procedure that, while historically only done with cheek implants, is now done more often by injection methods using synthetic fillers or fat.
The emergence of injectable methods is now the most common approach for cheek augmentation. Any of the synthetic fillers can be used since the cheek is a broad area and is spread out over the cheekbone as well as below it in the submalar region.While no synthetic injectable filler provides a permanent result, it does provide an instantaneous result and the opportunity for the patient to determine if this type of facial enhancement is appealing to them.
Cheek implants offer the only guaranteed permanent method for cheek augmentation. But this requires a surgical commitment to an invasive procedure and has certain risks and complications. Injectable fillers can also be placed over a broader surface area greater than that which most cheek implants can.
An interesting but relevant issue when using injectable fillers for cheek augmentation is how do they compare volumetrically to that of cheek implants. To create an injectable cheek augmentation effect, what volume of injectable filler is needed to compare to what a cheek implant does? An injectable method is only a fair test in facial augmentation if similar volumes of material are placed that compares to what an implant does.
Comparing facial implants and injectable fillers is done using volumetric displacement. Based on the Archimedes principle of displacement, volume of displaced water would equal to the volume of the implant. (provided that they sink in water and cheek implants do) Using the most commonly used style of cheek implants (Conform Submalar and Conform Malar Shells from Implantech) of all available sizes, their weights in grams and volume displacement were as follows:
SUBMALAR CHEEK IMPLANTS
Small 1.89 grams 0.7ml
Medium 2.13 grams 0.8ml
Large 2.36 grams 1.1ml
Large 2.58 grams 1.3ml
MALAR CHEEK IMPLANTS
Extra Small 1.47 grams 0.6ml
Small 1.71 grams 0.7ml
Medium 1.96 grams 0.8ml
Large 2.43 grams 1.1ml
Extra Large 2.62 grams 1.3 ml
The volume displacement of all injectable fillers is on the syringe so the comparison to cheek implants can be directly compared. It shows that a 1cc syringe of any of the hyaluronic acid-based fillers (e.g., Juvederm) would be equal to small and medium sized styles of cheek implants.ess than even a small chin implant. Larger cheek implants more directly compare to a 1.5cc syringe of Radiesse.
Volume alone, however, is not the complete story of any material’s external facial augmentation effect. Besides volume there is the issue of how well the material pushes on the overlying soft tissues to create their effect. This is known as G Prime Force or the elastic modulus. By feel it is obvious that cheek implants are stiffer than any liquid material and would have a higher resistance to deformation. (thus creating more outward effect given a similar material volume) It is therefore probable that comparing volume displacements alone overestimates the effect of injectable fillers compared to implants.
The comparison between injectable fillers and implants in the cheeks may be different than in many other facial enhancement sites. Because the cheeks cover a significant soft tissue area not supported by bone the direct volumetric comparison may be more similar despite its lower elastic modulus.
Dr. Barry Eppley