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Cheek implants are a common type of aesthetic structural facial augmentation surgery that is only secondary in number performed to chin implants. They are usually placed through an intraoral approach crossing the concave surface of the maxilla in the subperiosteal plane to place the implant at various positions on the malar/submalar area. Far less frequently cheek implants  are placed through a lower eyelid approach which is either done due to convenience (if lower eyelid surgery is being concurrently performed) or at the request of the patient.

An additional route of cheek implant placement is through a preauricular approach. This enters the subperiosteral plane at the anterior zygomatic arch and /or on top of the deep masseteric fascia just below the zygomatic body. This requires penetrating through the SMAS layer amidst the buccal branches of the facial nerve. This has the obvious advantage of avoiding an intraoral entry and a lower risk of infection. But it is usually only used when the patient is already having a facelift so this point of access is one of opportunity and convenience.

There is also the opportunity in which both the intraoral and preauricular approaches are used. In a large custom cheek implant which extends over the maxilla into the paranasal region is an implant size in which the dissection can not be completely done from a facelift approach or intraorally either.

The intraoral approach is initially used to get the majority of such a large custom implant into place. But when the facelift is done only a thin layer of tissue lies over the distal end of the implant just underneath the SMAS layer. The SMAS layer is opened and the implant exposed.

Through this access the position of the posterior half of the implant can the checked, repositioned if needed and screw fixation applied. The SMAS layer is then closed over the implant and the facelift completed.

When standard cheek implants are placed through a facelift approach their size is relatively modest and getting them positioned over the cheekbone is fairly straightforward. But large custom cheek implants are very different and malposition is more likely as the posterior end of the implant can not be seen.     

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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