Background: Cheek augmentation, like all forms of facial enhancement, have gender specific characteristics. While some women may seek increased fullness in the lower cheek area (malar/submalar) while men usually prefer it to be higher and more completely sitting on the bone. In essence women often prefer fuller cheeks while men prefer a more defined or angular cheek look.
Of all available standard facial implants the single most common aesthetic error I see is in male cheek implants. This is partially a lack of understanding the difference in the male vs female cheek shapes as well as using standard cheek implants that often have little chance in achieving a satisfactory result. The limitations of standard cheek implants in men are very obvious when looking at postop 3D CT scans of male cheek implants.
The key to understanding cheek implants in men vs women is in their shape.To create more anterior cheek fullness the implants needs to have an oblong or downward curved shape. To create a higher cheek look the implant shape must follow the upward curve of the cheekbone back along the zygomatic arch. These different implant shapes require variations in their pocket developments in and around the zygomatic body and arch.
Case Study: This male presented for cheek implant replacements with an unsatisfactory result from a primary cheek implant procedure. He decided now that a custom cheek implant design was necessary. His 3D CT scan showed submalar cheek implants placed low and anterior to the way they were initially designed to be used. They were maxillary implants more than cheek implants.
Using his 3D CT skull high cheek implant designs were made which covered the zygomatic body and arch in a reverse curvature to his current implants. The maximum projection was not large (2.5mms) but the bone coverage was complete.
Under general anesthesia and through an intraoral approach the submalar implants were removed and compared to the new custom cheek implants. Of note is the reverse curvature of the implants, m one creating a low cheek augmentation effect while the other a high cheek augmentation effect.
In placing high cheekbone implant it is necessary to dissect all the way back along the zygomatic arch. To so do properly and not end up in the soft tissues of the cheek over the distal half of the arch a long curved dissector instrument is needed.
The cheek implants are then inserted with particular attention paid to the very tail of the implant which can not be seen. These thin tails can easily be flipped or bent if the arch pocket is not completely free from the bone. Once in position a single microscrew anteriorly secures it to the main zygomatic body.
The high cheekbone look necessitates an implant shape that is not currently available as a standard cheek implant.
Case Highlights:
1) Submalar cheek implants in men are rarely the look they re trying to achieve.
2) Most men seek various forms of the ‘high cheek bone’ look which requires an implant which covers the most convex part of the zygomatic body and arch.
3) Intraoral placement of the high cheekbone implant requires a long curved periostea dissection to stay on the bone over the zygomatic arch.
Dr. Barry Eppley
World-Renowned Plastic Surgeon