Cheek implants have been around for over fifty years but despite this long duration they are few techniques described as to how to place them. Most cheek implants are placed through an intraoral approach which is the most direct line of access to where they are typically placed. In watching surgeons do the procedure I frequently see a low horizontal mucosal incision under the upper lip which is moderately long. Then a wide subperiosteal pocket is dissected across the face of the maxilla up over onto the main body of the cheekbone. While this creates wide open access to place the implant in an unobstructed manner it is actually not necessary and exposes the implant than increased risk of oral contamination as well as exposure should the wound closure breakdown.
An improved technique is a high limited mucosal incision. Using a cheek retractor the upper lip is lifted and the mucosa pinned against the bone. Then a very small incision is made which immediately goes right down to the bone. Through this limited incision elevators are used to scrape the bone and create an initial subperiosteal pocket over the anterior and lateral surfaces of the cheek bone. Once this is done a larger elevator is used to sweep down from the bone onto the masseteric fascia for most standard cheek implant styles used in women.
Interestingly sweeping down onto the masseteric fascia is frequently associated with a sudden release into this tissue plane.This is actually the same tissue plane in which a deep plane facelift is done. In essence a properly placed cheek implant provides an anterior deep plane lifting effect which will float on the top surface of the implant since it has been released.
Through this small incision much larger cheek implants can be placed than one would think. The pocket made inside is much bigger than the entrance incision used to make it. The implant should lay passively once inside the pocket and its position should match the skin markings of the implant outline placed before surgery. A single screw is used to secure it to solid bone that does not have the maxillary sinus under it.
A few restorable sutures are all that is needed to close the incision which now drops down away from the implant.
The placement of standard cheek implants in a female can be done very effectively through a small high intraoral incision with minimal bleeding. By keeping the incision ‘high and small’ the risks of infection and wound dehiscence are lowered.
Dr. Barry Eppley
Indianapolis, Indiana