While standard cheek implants can address most aesthetic cheek deficiencies, certain cheek augmentation needs require a custom implant approach. When the amount of augmentation size, surface area coverage or unusual anatomy/asymmetries exist, a 3D CT scan is needed to customize the implant designs to fulfill the patient’s aesthetic needs.
While custom implants can provide a lifetime of cheek augmentation stability, facial volumes may change over time. Weight loss/gain and facial fat loss due to age, disease or medications can cause a loss of cheek subcutaneous volume. While such cheek volume loss could be restored by designing new custom implants, adding to what already exists is an alternative strategy.
Standard cheek implants can be added to custom cheek implants on either an overlay (on top of ) or underlay (underneath) technique. For more significant changes the overlay implant placement produces the most significant external change as it uses the custom cheek implant as a platform to push on then overlying soft tissues. Once inside the implant pocket the non-adherent surface of a silicone implant provides a smooth place of dissection and implant placement. The overlay implant is then sutured to the custom cheek implant.
The underlay implant technique, also called a wedge implant, pushes out on the overlying custom cheek implant. Its effect is less significant than the overlay implant as its effect is dampened by the pressure of the overlying custom cheek implant. In essence the further away you are from the desired location of the augmentation, the less effect that is created by similar implant volume/size. (if it were placed as an overlay) For smaller amounts of additional augmentation wedging an implant underneath the existing one can be effective. In some cases I have even combined an overlay and underlay implant to optimize the secondary augmentation or improve some residual asymmetry.
Dr. Barry Eppley