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The most successful method for cheek augmentation in most males is augmentation along the infraorbital-zygomatic arch line using an infraorbital-malar (IOM) implant. Since this creates a line of horizontal bone enhancement across the cheek area, it successfully creates the often sought after high cheekbone look. This is in contrast to what a standard oval cheek implant achieves when placed over the zygomatic major bone often in an oblique orientation.

While every IOM implant is made for each individual patient from their 3D CT facial scan, many of their designs share an overall similar footprint. (outline on the bone) And to avoid creating a high cheek augmentation effect that is too strong or extreme there are also guidelines to various thicknesses at specific points along the implant design. For example it is usually advised to rarely go over 4mms at the main cheek projection at the turn of the curve. With these consistencies a standard IOM implant could be made that would suit some patient’s aesthetic needs that would make the custom design route unnecessary for some patients.

When placing an IOM implant it is always tempting to think that it can be successfully done from the intraoral route. But when trying to place an implant whose orientation is perpendicular from a vertically inferior direction creates a significant chance of implant malposition. The best approach is a hemi- lower eyelid incision. This is an incision that is a 3mm lateral canthal extension that crosses the outer half of the lower eyelid 1mm below the lash line. This spares separating the orbicularis muscle at the inner half of the lower eyelid. This portion of the pocket and implant placement can be done with a tunnel technique. Sinilarly the longer part of the implant over the zygomatic arch is dissected with partial vision of the arch. But the direction of dissection is completely horizontal, unlike the intraoral route, and can be done by external palpation and internal feel of the dissector along the thin arch bone.

Positioning and screw fixation of the main body of the implant is done under direct vision. While this does not make implant malposition impossible it dramatically lowers that risk along with that of lowering the infection risk as well.   

Dr. Barry Eppley

Indianapolis, Indiana 

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