Cheek augmentation in men is distinctly different than that for women. Women often seek to achieve a more anterior cheek fullness with an apple cheek appearance. To achieve that effect oval-shaped cheek implants are placed over the cheekbone with some of the implant off of the bony prominence. Conversely most men seek a cheek augmentation look that is higher and situated completely over the bone. (high cheekbone look) Lower anterior cheek fullness is to be avoided in men as that can have a feminizing effect.
Many male cheek augmentations are associated with an undereye/tear trough deficiency. This is due to the inward tilt/underdevelopment of the zygomatico-orbital bony complex. As a result infraorbital as well as cheekbone augmentation may be needed and this constitutes what is known as the infraorbital-malar (IOM) cheek implant design. By having a horizontal line of augmentation from under the eye that goes around the ‘corner’ onto and across the zygomatic arch…the high cheekbone look occurs.
In placing the custom IOM implant the lower eyelid incision is by far the preferred approach. Getting the implant in the complete horizontal orientation is best done with a linear line of pocket dissection. A complete lower eyelid incision is not necessary as only the outer half (pupil to lateral canthus) of the eyelid incision is needed. While it can also be placed through an intraoral approach there is a higher risk of infection and implant malposition as well as potential prolonged infraorbital nerve dysesthesia and even some buccal motor nerve dysfunction. When the implant saddles the infra orbital rim, as many IOM implants do, it is virtually impossible to get it properly positioned from below.
Once the pocket dissection is completed the implant can be inserted with the longer arch portion first and the shorter rim section thereafter. The implant needs to lay completely flat without any buckling. Buckling indicates inadequate pocket dissection. Once in position a single 1.5mm self-tapping screw is used into the zygomatic body just below the lateral orbital rim.
The IOM cheek implant is often the preferred midface augmentation method for men. It provides the high cheekbone look as well as improves undereye hollows and negative orbital vector globe-bone relationships. The lower eyelid approach is associated with the lowest risk of complications in terms of infection and malposition. A careful eye in surgery must be paid to the prominence of the implant projection at the ‘corner’ as it is very easy to create over augmentation and an unnatural appearance in that area of the cheek.
Dr. Barry Eppley