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Feminine cheeks typically have more fullness in the ‘apple’ cheek area which is on the front part of the cheekbone. (malar-submalar zone)  This aesthetic female cheek roundness is historic although more contemporary trends for cheek augmentation are for a line of fullness that extends back along the zygomatic arch as well for more defined and linear cheek highlights. The desired cheek augmentation look will help define the best method to achieve it.

The most common non-surgical method for cheek augmentation is done with the use of injectable fillers. A wide variety of injectable fillers now exist and more highly cross-linked hyaluronic-acid fillers (e.g., Voluma) work well in the cheeks. Longer-lasting effects can come from Sculptra although multiple treatments are needed to achieve the optimal effect. While these are effective they are not permanent which on the surface seems unfavorable. But more permanent injectable fillers should be approached with caution. Should an inflammatory response develop or lumps/irregularities occur months to years later, they can be more difficult problems to solve.

Fat injections are a surgical technique for cheek augmentation that is appropriate to consider when one is already having other surgeries. Using one’s own fat is a ‘natural’ approach that has its best track record of survival in the cheeks. Fat injections can be very effective for the softer look of a cheek augmentation.

Permanent cheek augmentation can be done using either standard or custom cheek implants. Several different styles of standard cheek implants exist for the malar, submalar and combined malar-submalar cheek areas. The combined malar-submalar implant, known as the malar shell implant, is most commonly used for its more complete volumizing effect. If one desires a higher cheek look with augmentation that extends back along the zygomatic arch a custom cheek implant design is use. With either type of cheek implant an intraoral approach is used for placement.

An autologous or natural type of cheek augmentation can also be done by moving the cheekbone outward in a procedure known as a Zygomatic Sandwich Osteotomy. (ZSO) Through an intraoral approach an oblique osteotomy is done through the zygomatic body of the cheekbone. The cheekbone is moved outward and fixed with a plate and screws with or without an allogeneic bone graft. This type of cheekbone osteotomy creates lateral cheek fullness in the front part of the cheek.

Another cheek enhancing procedure is that of dimpleplasty. Cheek dimples can be created through an intraoral technique. Cheek dimples occur naturally because of a defect in the zygomaticus major muscle. This can be created by making a defect in the intraoral mucosa up to the underside of the skin in the desired dimple location. By suturing the underside of the skin down into the defect a dimple is created. Dimples occur only when smiling (dynamic dimples) or exist at rest and get deeper when smiling. (static dimples) The surgical techniques are slightly different to create either one.

Dr. Barry Eppley

Indianapolis, Indiana

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