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Permanent aesthetic augmentation of the midface is done by cheek implants. While there are other areas in the midface that can be augmented, the cheeks are done the most frequently. A variety of standard preformed styles have evolved over the years that largely provide differing amounts of augmentation over the main body of the zygoma. There is some coverage of the posterosuperior maxilla and the front part of the zygomatic arch but this is more for a feathering of the implant edges.

But like all fashion styles they evolve over time. This is no different for the aesthetics of cheeks. Desirable midface looks today often show cheek highlights that sweep back over the zygomatic arch. Models show varying locations of malar and submalar augmentations but the sweep back over the whole length of the zygomatic arch remains the same. This is a look that can not be obtained by any standard form of cheek implant.

This more dramatic cheek augmentation look requires an implant that extends back over the whole length of the zygomatic arch and can be called the malar-arch style or the extended cheek implant. This implant starts further down on the maxilla and creates a sweep of material far back along the arch almost to the ear. That is a much different implant design compared to standard cheek implants and is actually a more anatomic design as it covers the cheek or zygomatic-maxillary complex more completely.

There may be some subtle differences between men and women for the extended cheek-arch implant design. Men may want less fullness in the anterior aubmalar cheek area in effort to have more of a hollowed or ‘chiseled’ appearance if their soft tissues will permit it. But the implant sweep back across the zygomatic arch remains important.

The extended cheek-arch implant is still placed through an intraoral incisional approach. The zygomatic arch must be done carefully to keep the dissection on the thin arch. It must also be done completely subperiosteal to avoid injury to the frontal branch of the facial nerve as it crosses over the posterior arch up into the temples.

Dr. Barry Eppley

Indianapolis, Indiana

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