Of all the potential areas of facial skeletal augmentation, cheek implants are the second most commonly performed location. Having noticeable and strong cheek bones is considered just about part of every aesthetically pleasing face, There are gender and other ‘look’ differences in the dimensions of the cheek prominences but their presence is a key aesthetic element of an attractive and proportionate face.
Unlike the chin or the nose, the cheeks represent a paired area of facial bone prominences and this accounts for some of the unique considerations when surgically enhancing them. The cheek implants must not only be symmetrically placed but must have the right shape and size to give the cheeks their desired look.
While cheek implants used to be thought as two oblong shapes that were positioned right over the front edge of the zygomas (cheeks), that original approach was just the first step in how far cheek augmentation has come today. Understanding the different shapes of contemporary cheek implants can create a cheek look that best suits their face. They fundamentally break down into three types based on what area of the cheek they augment.
The traditional cheek implant is now described as a Malar Shell. It is called that because it sits over the curved zygoma and augments it in a near 120 degree arc. It most closely mimics the natural shape of one’s zygoma and just makes it bigger. For people with flat cheekbones from the lateral infraorbital rim down, particularly those who have a negative vector, this implant produces a natural and not overly prominent effect.
In the mid-1990s, the submalar implant was a revolutionary improvement in the few cheek implant styles that were available. It is designed to sit on the lower half of the cheek bone, creating more fullness below the cheekbone prominence and helping to pick up any sagging cheek tissues. It was even touted as a volumetric midface lift. It creates that effect in the patient with midface aging as well as one who has submalar hollowing from facial lipoatrophy.
For those patients who are in need of a more total cheek augmentation effect combining the malar and submalar areas, there is the Submalar Shell implant which can also be called the Midface Implant. Putting the two together gives a combined bone augmentation to the cheek prominence and a volumetric fill to the area below…a combined bone and soft tissue effect.
While not a different style, several features have been added to these cheek implant shapes that help them adapt to the bone better and provide increased soft tissue fixation. The Conform feature is that implant is no longer a solid piece but has a grid pattern on its backside that allows the ultimate in adaptability to the bone. (increased flexibility) The addition of a 0.3mm layer of Gore-Tex on the outside of the silicone implant provides a semi-porous outer layer for soft tissue to quickly grow into and fix the implant in position. (if a screw is not being used)
Selecting the cheek zones to augment is the key in selecting the proper cheek implant style. Selecting the right size of implant, however, is more of an art than an exact science as there is no quantitative measurement to make that determination. But in general it is usually better to be more conservative (smaller) than one would think as these broader surface area cheek implants of today can create a bigger effect than one might think when just holding them in your hand.
Dr. Barry Eppley
Indianapolis, Indiana