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Cheek implants are a well known method of adding assured volume to the midface. The term ‘cheek’ however can have various meanings to different patients and the area of some patient’s cheek augmentation may be slightly or considerably different. Given that the cheek area is a broad anatomic area, extending from the lateral orbit to the tail end of the zygomatic arch, it is not a surprise that standard shapes and sizes of commercially available cheek implants are not ideal for every patent’s cheek augmentation needs.

One such unique cheek augmentation area is that of the anterior malar or inferior orbital-malar region. Situated just under the eye and at the junction of the infraorbital rim, superolateral maxilla and the anterior zygoma, its augmentation requires a uniquely shaped implant that is fixed securely.

Given that there is no standard preformed implant for this type of cheek augmentation, it become necessary to modify an existing cheek implant to do so. What matters is not the style of cheek implant chosen to modify but that it is modified into an appropriate shape. Its shape is more rectangular than oblong with the thickest part closest to the zygoma and the thinnest blending into the maxilla and ending just lateral to the infraorbital nerve. Given that it will end up in a virtual ‘side of the cliff’ location, screw fixation is necessary.

Anterior cheek augmentation may be desired in those patients who already have good lateral cheek fullness or mid facial width and prefer to extend it further forward. It may also have a useful role in the patient that already has cheek implants and similarly want an extended area of midface augmentation. The zone of augmentation lies between the anterior curve of the zygoma and the infraorbital nerve exit from the bone.

Dr. Barry Eppley

Indianapolis, Indiana

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