Cheek augmentation is most commonly performed today by injectable fillers. But when filler fatigue sets in cheek implants offer a permanent augmentation method. Cheek implants have been around for a long time and a variety of styes and sizes exist. Their use has historically been for females of which the same still exists today. But more men than before seek midface augmentation and what has been used in the female face does not always aesthetically work well in men.
The current styles of cheek implants create fullness in the malar, submalar or combined malar-submalar midface areas. This creates a rounded fullness in the anterolateral cheek areas which is why it is known as the ‘apple cheek’ effect. While this rounded cheek effect may be a desired outcome for some women, it almost never is for men. The effects of current cheek implant styles on a male face can be seen on 3D CT scans where, even with perfectly symmetric implant placement, it is easy to see that a lower rounded midface effect is created.
Rather than a round cheek look, men prefer the ‘high cheekbone look’ for which no standard cheek implant style can create. Such a look can currently only be created by a custom implant design approach. In these implant designs the footprint of the augmentation is not rounded but linear along the bony horizontal line right along the bottom of the eye out onto the zygomatic arch. The male high cheekbone implant comes in two basic styles, the extended cheek-arch implant and the infraorbital-malar implant.
In the extended cheek-arch implant style the concept is that the implant goes across the main zygomatic body and extends backward along the entire zygomatic arch. It creates a near linear line of augmentation with a 10 to 20 tilt to the line of the cheek augmentation from front to back. In some cases It is inserted through an intraoral incision. To help with its placement material can extend in front of the cheek under the infraorbital nerve. These areas are often trimmed off once the implant is positioned and secured.
The other basic high cheekbone look implant is the combined infraorbital-malar style. This implant footprint is completely linear as it augments the infraorbital rim under the eye all the way back along the zygomatic arch. It is for those that need a combined undereye hollow and cheek augmentation effect. Because of its completely linear augmentation effect, and because to often saddles the infraorbital rim, it is placed through a lower eyelid incision. This is the only way to ensure proper placement.
It is easy to see in replacing standard cheek implants in a male with custom infraorbital-malar implants the difference in their shapes…and thus the effect they would create.
It is possible in some custom infraorbital-malar implant styles to try and place them intraorally. But one has to be aware that the revision rate in doing so is higher do to asymmetry risks. There will also be more prolonged infraorbital nerve numbness due to the need to circumnavigate around the nerve to get the implant into position along the infraorbital rim.
Dr. Barry Eppley