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Ogee is defined generally as a curve. It has been given various descriptions such as an extended S, serpentine or having a sigmoid shape.  In particular it is a double curve in which a combination of two semicircular shapes meet centrally in an inverse relationship. The arc of these semicircular shapes can vary widely. When it is used in objects such as the arches in architecture it has a very specific geometry which can be designed and measured. It has numerical value since it is a mathematical term meaning an inflection point.

The ogee concept is frequently spoken of in aesthetic facial surgery, almost always referring to its use in cheek augmentation with injectable fillers. It is used with the intent of creating a prominence over the cheekbone as it transitions to a submalar hollow below it. Loss of a cheekbone prominence is associated with aging due to tissue descent or from lack of natural cheekbone development. Not having an ogee curve essentially means one has flat cheeks or lacks anterolateral cheek projection.

While the ogee curve concept is spoken of as having great aesthetic importance by plastic surgeons and injectors, it has never been precisely defined. Exactly what the curve should look like in terms of projection (how much is enough or what is too little) or what the ideal shape of the curve should be is not presented. This is undoubtably due to the imprecise nature of the techniques used (injectable fillers) where the creation of some general fullness as seen by the naked eye is about as precise as it can be.

The opportunity to create very precise shaped ogee curves, however, exists in the design and implantation of custom cheek implants. While surgeons naturally look at how much projection a cheek implant creates, very similar to that of a chin implant, they largely look at the thickness of the implant. This two-dimensional approach tells only part of the effect cheek implants can have and is really not the most important part of its aesthetic effect.

Its shape and thickness in the oblique profile is what primarily determines the effect of an implant on the aesthetic outcome of cheek augmentation. This not only creates the superior part of the cheek ogee curve but allows a visual assessment of his shape as well as a measurement of the apex of the curve. The shape of the bony ogee curve can then be compared to the augmented ogee curve to assess potential outcome. Does it look natural and like it belongs there or is the shape of the curve or the amount of projection (surface area under the curve) excessive?

Should a cheek ogee curve be a high, centric or low shape and how much should the maximum projection under the apex of the curve be? The neutral centric shape is usually the norm with high or low shapes dependent on the patient’s external cheek/midface appearance. The surface area under the cheek ogee curve represents the implant’s volumetric effect. While one could measure that surface area by integration that is obviously impractical. Instead one looks at the prominence of the curve using different thicknesses to see what looks best. It is not a precise science but it usually avoids an implant that looks too big or unnatural.

The ogee curve assessment provides the third dimension in custom cheek implant design that has been historically the hardest to determine because it is not a classic profile facial feature. It adds an element in the design that is missing from the front, side, top and bottom views commonly used in 3D implant designing.

Dr. Barry Eppley

Indianapolis, Indiana

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