Background: Facial lipoatrophy is a well known condition that is defined by fat loss in the face. This is most evident in the cheek and temporal areas where the largest collection of the fat exists in the face due to the buccal fat pad and its extensions. There are a variety for reasons why such fat loss occurs. Some have it naturally and it is their genetically shaped face while others develop it through various medical conditions, medications and large amounts of weight loss.
In the treatment of facial fat loss a variety of non-surgical and surgical options exist. Injectable fillers, particularly Sculptra, have been designed to treat facial lipoatrophy. While not permanent it does not provide a sustained effect for 1 to 2 years. Injectable fat grafting is also a minimally invasive surgical option but the take and persistence of fat is not always predictable and permanent.
Cheek implants provide an effective augmentation effect that is both assured and permanent. But not just any cheek implant will suffice. A typical cheek implant is designed to augment the bone while in facial lipoatrophy it is the area under they cheek bone, where the buccal fat pad resides, that needs the volume. This is the role of the submalar cheek implant. While it was originally designed as a complement to facelift surgery to create a midface lifting effect, and it is still good for that purpose, it also works well for a buccal fat pad replacement.
Case Study: This younger male had submalar cheek implants originally placed 25 years ago due to facial fat loss. While he had some injectable fillers placed around the implanted areafor nasolabial fold augmentation and acne scar treatments the submalar cheek augmentation effect remained and looked completely natural. (no implant show)
Submalar implants were a novel concept when they were introduced forty years ago for a unique midfacial augmentation effect. They can be placed in several different locations on the underside of the cheekbone (hence the name submalar) for slightly different effects. Because they don’t sit over the cheekbone proper there is no long term chance of implant show as the cheek tissues atrophy or fall.
The fundamental principle of facial implangts is that the exert their effects through a soft tissue float. The soft tissues are released from the bone to create the implant pocket, an implant is placed on the bone and the released soft tissues then float on top of the implant. This basic implant concept is mostly clearly seen in all forms of cheek implants. In the submalar cheek implant the deflated tissues on the underside of the cheekbone are pushed out and up from the placement of the implant.
1) The definitive treatment for midfacial lipoatrophy is implant augmentation due to its assured volumetric enhancement and permanency.
2) The submalar cheek implant most effectively replaces the buccal fat pad that has been lost.
3)The submalar cheek implant maintains an effective correction over time as seen in this 25 year followup.
Dr. Barry Eppley