Background: While cheek implant augmentation has been performed for decades there is no uniform change that all patients seek. While standard cheek implant styles and sizes exist the effects they create are uniformly desired by all. Understanding the exact dimensional changes to the cheek will determine if standard implants, modified standard implants or custom cheek implants are needed to achieve the patient’s desired aesthetic result.
Most men who seek cheek augmentation are after a different effect than that of what women have desired in the past. Rather than an anterior cheek fullness, which can feminize a man’s face because it creates a rounded effect, a more skeletal look or line of augmentation is desired which is more masculine. The key here is to follow the natural skeletal line of the cheek.
There are four zones to consider in cheek augmentation, the more central malar and submalar areas, the anterior infraorbital extension and the posterior arch extension. What is clear is that in those patients who seek a high cheekbone look must generally avoid the submalar region. The infraorbital extension is only necessary if the patient has undereye hollows and is the key consideration for when the lower eyelid incisional placement technique is needed.
Case Study: This male had a prior history of a jawline implant and wanted to complement that effect with better cheekbones. He already had decent cheekbone structure but wanted to highlight them further. To achieve an enhanced high cheekbone look custom infraorbital-malar implants were designed to go from the side of the nose back along the entire zygomatic arch. The maximum projection thickness at the anterior cheek area was 4mms.
Under general anesthesia and through a partial lower eyelid incision the custom infraorbital-malar implants were placed. A trial fit showed that the cheek projection looked too strong so it was reduced to 3mms.
His four month result showed an enhanced high cheekbone look that was not overdone and looked natural with the result of his well sculpted facial features.
In designing custom infraorbital-malar implants, most of which are for men, the critical feature in the design is the location and amount of cheek projection. The maximum projection location can be anywhere along the curve from anterior, mid to posterior locations depending upon the patient’s desired look. The amount of cheek projection (thickness) will also vary with most thinner patients almost never needing more than 3 to 4mms. Patients who seek a very strong cheek augmentation effect can have more but I always remind them that it is an area that is very easy to make too big. Fortunately, as illustrated in this case, it is always possible to hand reduce an implant that appears to be too strong.
Case Highlights:
1) Males often seek a higher cheekbone look that more closely parallels the natural skeletal line of the midface.
2) The infraorbital-malar cheek implant style is what creates the high cheekbone look as it covers this linear line of midfacial bone.
3) The key thickness to be cautious of in the infraorbital-malar style is where it turns the corner from the eye to the side of the cheek.
Dr. Barry Eppley
Indianapolis, Indiana