The cheek area is a central and critical element of one’s facial appearance. Situated between the pyramidal landmarks of the eye, mouth, and jaw angle, its prominence (or lack thereof) provides projection to the middle of the face. In today’s society, the perception of high or prominent cheekbones is one that is a positive statement about attractiveness and beauty. It is not clear why high cheekbones cast this image, but we all know the emotional response when we see it.
Today’s plastic surgery techniques and modern facial implants now make it possible to provide a wide range of cheek enhancements. Highlighting different areas of the cheek complex is made possible because of the many different styles of cheek implants that are available. Different cheek implant shapes are available that can enhance the front, side, underside, as well as the bone underneath the eye in front of the cheek. Because of these different style options, it is critical that a plastic surgeon look carefully at the anatomy of the cheek to determine which parts of it should be improved.
The ‘traditional’ cheek implant is really like a shell which covers all aspects of the curved cheek, adding volume to the front and sides of it in equal amounts. For those patients with really flat cheeks, this is usually a good choice. The implant can be slid further forward or further to the back of the cheek to customize its effects. Submalar cheek implants sit more on the underside of the cheek bone. They push up loose overhanging cheek tissue and , as a result, are more ideal for the aging patient with loose or sagging cheek skin. They also are good for patients who have had loss of the buccal fat pad and hollowing of this area. (facial lipoatrophy, e.g., HIV disease) Because the submalar implant fills the upper part of the buccal space as well as the underside of the bone, a dual effect is achieved. Tear trough implants are not really cheek implants per se. They fill underneath the eye area which is in front of the cheek. For those patients with some good cheek width but flattening of the bone in front of the cheek, this is the only facial implant made for that use. Sometimes it can be used in combination with a traditional cheek implant for greater fill of a flat midface.
To get the best effect from these different cheek implant styles, their position on the bone is critical. For this reason, I always secure any style of cheek implants to the bone with screws. This is the only way to be certain of their long-term position after surgery.
Dr. Barry Eppley