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Background: Cheek implants have been used for female midface enhancement for decades. While injectable techniques have come to dominate cheek augmentation today the use of implants still have a useful role to play. Current standard implants are designed to create an anterior cheek fullness which varies in the level of apple cheek fullness that it creates. (malar, submalar or combined malar-submalar) 

The use of cheek implants in females falls into two general categories of patients, younger and older. The younger female typically is seeking to enhance a naturally weaker bone structure for an improved facial shape. The older female may seek a cheek enhancement due to fallen or sagging cheek tissues…which is magnified when less pronounced cheekbones exist.

An interesting variation on this younger vs older female cheek augmentation is the older patient who presents for a midfacial rejuvenative effect with existing cheek implants that were placed when they were much younger. To have an enhanced effect now the size and style of cheek implants needed will be beyond what standard implants can provide.

Case Study: This female had standard double stacked cheek implants placed over 20 years ago. They were replaced last year with custom cheek implants, which while having an improved midface effect, did not fully address her cheek augmentation goals. She wanted a large cheek augmentation effect and was not afraid to go ‘big’ or extreme. At this degree of augmentation a cheek lifting effect will most assuredly be achieved.

New custom cheek implants were designed that had 9mms of projection but also had a maxillary extension into the paranasal region. This provide an extension of the augmentation effect of the cheek further into the anterior midface. The volume of each XL cheek implant was 10ccs.

Through her existing intraoral high vestibular incisions the previous cheek implants were removed and replace with these XL custom cheek implants.

These new cheek implants provided a significant improvement in the size and projection of her cheeks. Besides the volumetric addition there was also a notable cheek lifting effect. 

Case Highlights:

1) Most female midface augmentations desire to have an anterior cheek enhancement, particularly in the older patients who seeks a cheek lifting effect.

2) What defines an extra large (XL) cheek implant is as much about surface area coverage as it is thickness.

3) The XL malar-maxillary cheek implant provides the greatest apple cheek effect as well as a maximal mid facelifting effect.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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