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Cheek augmentation, particularly when done with implants, is typically perceived and done as a ‘lower cheek augmentation’. The tail of the implant may be up on the cheekbone but most of the implant is over onto the cheek soft tissues and the concave maxilla. The placement of cheek implants in this location can create a bit of a cheeklifting effect in some patients but in others it will create a lower cheek fullness and even deepening of the nasolabial fold.

To create more of a cheeklift, or at least avoid creating lower cheek fullness or depending of the nasolabial fold, higher cheek implant placement is needed. The concept of ‘higher cheek augmentation’ is based on having an implant that sits completely on the convex part of the cheekbone. This usually places the implant in a horizontal orientation and different styles cover varying lengths along the infraorbital-malar skeletal line. A cheek implant in this location, besides having a different aesthetic result from an implant placed lower, can more effectively create a cheek lifting effect as the volumetric push of the implant is higher.

Occasionally I will get a younger patient who wants a ‘cheek lift’ but has no significant cheek tissue ptosis. They are not a good candidate for a true cheek lifting procedure. And they often want a very high cheeklift location. One good way to achieve this effect is to place a very specifically shaped implant along side the inferolateral orbital rim. This is nicely accomplished by using the standard tear trough implant with a 2.5 to 3.5mm maximum projection. This implant location is also occasionally done for patients with flat cheekbone contours and a more inward angulation to the lateral orbital rim-alar complex.

While this inferolateral cheek implant could be placed intraorally such an implant location is a far distance from under the upper lip. A less traumatic and more assured implant placement is through a very limited lower eyelid incision. This allows direct access to create a discrete subperiosteal pocket just below the inferolateral orbital rim.Because the implant pocket is done from a superior direction the implant fits into it precisely and does not need any form of fixation.

Expanding the upper cheek soft tissues through release and volume displacement fills out a higher cheek area which creates the appearance of a lifted cheek. This can be an effective facial augmentation technique not only for younger patients seeking a ‘cheek lift’ but also in the older lower blepharoplasty patient int high a neutral or slightly negative orbital vector exists.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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