Facial lipoatrophy is a not uncommon facial condition that all of us have seen but didn’t know exactly what to call it. Some people call it ‘gaunt looking’, others may refer to it as ‘hollowing’ of the face. No matter what you call it, it is the result of loss of the buccal (cheek) fat pad that lies directly under the cheekbone (zygoma) prominence. The fatty layer immediately underneath the skin throughout the fat thins as well but the dominant feature is the sunken or dented in area immediately beneath the cheek.
There are numerous causes of facial lipoatrophy but the most common are aging in an alreadly thin person, advanced cancer or immune disease with significant weight loss, and loss of the buccal fat pad due to medications. (such as in the HIV patient who is on antiviral medication) The facial appearance is classic with the loss of roundness in the middle part of the face and an actual indentation where th cheek fat used to be. This gaunt look creates an unfavorable appearance that appears old or unhealthy.
There are two distinctly different methods in plastic surgery to treat facial lipoatrophy and rebuilt this area up andout, either using injectable fillers (including fat) or a special type of cheek implant. Both obviously attempt to fill the cheek void left by the vacated fat pad but approach it differently. Injectable fillers replace it either with a viscous liquid component which may or may not be permanent. Most injectable fillers are not permanent. Inject fat could be permanent but is unpredictable. I have not been a big fan of the injectable fillers for the cheek deficiency of facial lipoatrophy simply due to the volume of the filler needed and the subsequent cost. It doesn’t take long before one can approximate the cost of a surgery. For a more assured result, albeit a surgical one but it provides the best value, is the use of a submalar cheek implant.
Submalar cheek implants are a variation of the traditional cheek implant. They are not designed to build out the cheekbone prominence but fill out the submalar area where the buccal fat pad partially lies. They are surgically placed through a small incision underneath the upper lip. Different sizes are available dependent upon how much of a deficiency exists in the submalar area. Submalar cheek implants are placed on the underside of the cheek bone and are secured into position with s small screw to hold their precarious but important position. The effect of the submalar cheek implant is immediate. There is really no recovery other than mild soreness and some swelling for a few days.
The treatment of facial lipoatrophy with a submalar cheek implant is easy, satrightforward, and effective. While it only treats one component of facial lipoatrophy, the buccal fat pad area in the midface, this is often the most recognized and disfiguring component of the problem. The material that the submalar cheek implant is made out of is not of particular importance, whether it be silicone rubber, gore-tex, or other well-tolerated facial implant material. An artistic eye for proper cheek implant style and selection and accurate placement on the underside of the cheek bone are the keys to a pleasing outcome that can make the face appear more healthy and youthful.
Dr. Barry Eppley
Indianapolis, Indiana