The cheeks like the rest of the face is comprised of bony and soft tissue components that can be surgically modified. But what separates the cheeks from other facial areas is that the hard and soft tissue areas are not in the same anatomic area. The bony part is in the upper midface (cheekbones or malar area) while the soft tissue part lies below the bony cheeks in what is called the submalar region of the midface. To add a little confusion to the cheek terminology some refer to the very lowest part of the submalar area by the mouth and down closer to the jawline as the cheeks as well.
The relevance of differentiating cheek areas comes into play when surgically trying to create more defined cheeks or provide improved contour to a rounder or fuller face. Cheek definition surgery most commonly involves bone augmentation by implants and fat removal by buccal lipectomies. While effective for some this approach is limited by the placement of standard cheek implants, which often is not completely on the bone (thus not a high cheekbone augmentation) and that the buccal lipectomy is an incomplete cheek defatting procedure.
In the rounder fuller face a maximal approach is needed to get the best reshaping change that is possible. A cheekbone type implant that stays on the convex flat areas of the cheeks and away from its rounded inferior edge, combined with a zygomatic arch extension, provides the best cheekbone augmentation effect. (A truly high augmentation)
Below the cheekbone maximal cheek defatting requires a combination of compartmental fat removal (buccal lipectomies) and subcutaneous fat reduction. (perioral liposuction) This provides a complete cheek defatting effect from the cheekbone down to the jawline. Buccal lipectomies are a ‘spot’ reduction effect because it is localized to the upper cheek soft tissue area. Perioral liposuction covers a much broader area and its not as restrictive as the name implies. (aka not just by the side of the mouth) It can go way down to the jawline, up over the buccal lipectomy area and as far posterior as the anterior edge of the parotid gland.
The cheeks refer to a broad geographic region which is contains several regions within its borders. In cheek contouring surgery for enhancement definition all regions within the cheek zone may need to be modified to create the best effect. Only in the lean thin face will one zone alone b effective. Thus a multilevel cheek contouring approach works best for most patients.
Dr. Barry Eppley
World-Renowned Plastic Surgeon