Background: Cheek augmentation with implants has been around for over fifty years. While these implants have undergone various shape changes and are available in different materials over this time period, the most common cheek implant styles are oval in shape and are designed to augment the main zygomatic body. This creates an anterior cheek fullness or ‘apple’ cheek effect which is fine for some women but rarely desired by men.
In essence current cheek implants are fundamentally made for women which has comprised the vast majority of patients historically. But as more men seek cheek augmentation, that is often first tested with injectable filler, these traditional implant styles are usually not putting the augmentation effect in the right place for their desired aesthetic result.
Most men prefer a high cheekbone look for their cheek augmentation which fundamentally follows the natural shape of the entire cheek bone. The line of augmentation is linear and occurs at the level of the zygomatic arch. It keeps the augmentation away from the central midface and, instead, sweeps back across the zygomatic arch towards the ear.
Case Study: This male had cheek implants placed previously which resulted in anterior fullness to his cheeks which he did not like. He also felt there was some asymmetry to the implant placement. A 3D CT scan showed that the implants were a large submalar cheek implant style. The placement of these implants placed the main body of them over the maxilla….which created an undesired anterior fullness.
To create a more desired high cheekbone look custom cheek implants were designed that removed all the fullness from the maxilla/anterior cheek. The line of augmentation paralleled the zygomatic arch back to the temporal process of the skull. Maximum projection was 4mms anteriorly which faded to 2mms posteriorly. A maxillary tab was built into the design to help with placement which would then be removed prior to closure.
To fully appreciate the differences between the existing standard implants (dark green) and the new custom implants (teal color), the two were overlaid on the scan so the differences in their footprints could be seen..
Under general anesthesia and through an intraoral approach his existing cheek implants were removed and the new custom cheek implants placed. This requires removal of the existing capsule in the bone and an extension of the pocket back along the zygomatic arch. This is always a challenging implant to place as most of the implant pocket and placement must be done ‘blind’, using only their external appearance as a guide.
The high cheekbone look places the line of augmentation at either a near horizontal or completely horizontal orientation as it relates to the zygomatic arch. This is best seen by looking at the color thickness mapping of an implant design. No standard cheek implant as of yet can create this similar augmentative effect.
Case Highlights:
1) The use of standard cheek implants in men often create an undesired anterior cheek fullness that is not what most men are seeking from cheek augmentation.
2) The high cheekbone look requires a custom cheek implant approach where the line of augmentation is nearly horizontal back across the zygomatic body and arch.
3) Placing an extended high cheekbone implant intraorally is a challenge in getting the tail of the implant in proper position without being folded or bent.
Dr. Barry Eppley
Indianapolis, Indiana