Background: Augmentation of the cheeks is a frequently performed aesthetic facial reshaping procedure. While once only capable of being performed with implants, it is now more commonly done with synthetic fillers and fat. But the only assured permanent cheek augmentation result from a single effort is with the use of implants.
Like all implants placed anywhere in the body, cheek implants have the traditional medical risks of infection. Fortunately this is very low even though the intraoral route is a common incisional method of insertion. The most common risks with their use is aesthetic with an undesired outcome due to implant style, size or positioning on the bone.
In my experience cheek implant asymmetry is its most common aesthetic risk. This is a risk that is shared by any facial implant in which it is bilateral. (has a right and left side) While not commonly appreciated it is very difficult to get perfect facial implant symmetry when they have to be placed in pairs. There are a variety of reasons why implant asymmetry occurs but the fundamental reason is that the limited incisions do not allow for bilateral implant positioning assessment by direct vision.
Case Study: This 35 year male had cheek implants placed five years ago to improve flatter cheeks. He knew right after surgery that the implants were asymmetric and it had always bothered him since. He liked the right side but felt the left side was flatter. He finally decided to seek a solution and a 3D CT scan showed that the left implant was more anteriorly positioned and its shape was different from the right side.
Under general anesthesia and through his existing left maxillary vestibular scar, the left cheek implant was located. It was above the periosteum in a more superficial location and close to the infraorbital nerve. On its removal it could be seen that it had been modified in an irregular fashion. The purpose of the implant modification was unclear. The cheek implant was reshaped to a smoother upper contour and re-inserted and positioned as per the right side of the 3D CT scan. Double screw fixation was used through the implant to ensure its new position on the bone.
In comparing the implant with the preoperative 3D CT scan, it could be appreciated how accurate the scan was in both identifying the implant shape and its anatomic position in the patient. In addition without an exact knowledge of how the right cheek implant was positioned, it would have been impossible with any accuracy to know what the matched position was to the opposite ‘good’ side.
Highlights:
- Cheek implant asymmetry is common regardless of implant style and size.
- A 3D CT scan is essential when considering cheek implant asymmetry correction.
- Repositioning of one or both cheek implants is guided by the the 3D CT scan of the good side.
Dr. Barry Eppley
Indianapolis, Indiana