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Cheek augmentation is a common facial reshaping surgery that can be done by a variety of different methods. Temporary synthetic injectable fillers, fat injections and bone-based implants are available midface augmentation techniques, each with their own advantages and disadvantages. Surgeons may have their preferences but it is never such that one cheek augmentation methods works effectively in all patients.

Cheek implants offer the only assured volumetrically stable augmentation method that comes, of course, with its own set of surgical risks. But the most common risks are aesthetic in nature as selecting the implant style and size that will achieve the patient’s aesthetic needs is not always easy or simple. This issue becomes magnified by various factors, one of which is the patient’s ethnicity.

Very relevantly, all current cheek impact styles are really made for the Caucasian patient, particularly that of females. This is understandable as the historic patient for cheek augmentation was female and the surgeons who designed the original cheek implants are Caucasian. But today’s patient population for cheek augmentation has expanded to all genders and ethnicities. Thus current cheek implants and what they can achieve dimensionally must take the gender and ethnicity of the patient into consideration.

This becomes extremely pertinent in the Asian patient whose midfacial bony anatomy is very different than of Caucasians. Many Asian patients have less forward projection of the midface and comparatively increased midfacial widths. This accounts for the popularity around the world of cheekbone reduction surgery. Any surgeon performing cheek augmentation in an Asian male or female must be very aware of their specific dimensional needs….which is best thought of as ‘high and anterior’ on the cheek. In other words more to the front of the midface than to the side.

With this understanding the real question in the Asian patient is whether this is best accomplished by the use of standard or custom cheek implants? If the patient does not want any infraorbital or midface augmentation effects (particularly along the infraorbital rim) then the use of standard cheek implants may be sufficient.

In my experience in some Asian male and female cheek augmentation patients the use of a standard malar shell style of cheek implant is effective. But the key is its placement on the bone and the implant’s orientation. It needs to be placed more anterior as well as the implant needs to be inverted (turned upside down) to create the desired high anterior cheek augmentation effect. This allows the thicker part of the implant to be higher up on the cheek. This avoids creating too much fullness down low which would make the lower cheek too heavy/puffy.

Technically this also means the right cheek implant need to become the left one (placed upside down) and vice versa. (cheek implant inversion)  The cheek implant is also oriented more horizontally and less at a 45 degree angle, keeping its fullness high on the anterior cheekbone.

Screw fixation of this inverted cheek implant placement in the Asian patient is essential. Keeping the implant high up on the anterior cheek bone right up against the infraorbital rim can not be assured by any other method.

Dr. Barry Eppley

Indianapolis, Indiana

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