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Cheek implants have been around for decades gong back to the 1970s. Their styles have evolved into malar, submalar and combined malar-submalar (malar shell) designs. They can be used in the younger patient for aesthetic cheek augmentation as well as in the older patients to create a form of a midface lift and voluminization effect. While the various styles have some differences how they are designed, they largely have an oblong or extended oval shape.

Compared to what cheek implants initially were today’s designs blend in better with the surrounding bone and on top of the masseteric fascia. Their aesthetic effect, however, is restricted to main body of the zygoma. As a result they create an anterior cheek fullness that is often referred to as an ‘apple cheek’ look. This is a cheek look that can work well for some women but rarely is a desirable one in men. It tends to feminize the face and does not create the high cheekbone look that many younger men seek.

The term ‘high cheekbones’ is thrown around frequently and has been given slightly different definitions. Some describe it as when the widest part of the face is just below the eyes. Others refer to it as chiseled cheeks which causes a dip to occur below the cheek bones. But from an anatomic standpoint it is accentuation of the entire natural cheekbone which means both the main body of the zygoma and the zygomatic arch behind it. When this is augmented a distinct horizontal or tilted horizontal line occurs from below the orbits back towards the ears. For the people who have it naturally it is because their natural zygomatic body and arch is more laterally developed.

The high cheekbone look can not really be created with standard cheek implants. Some may try by pushing back their extended oval shape more posteriorly but it is still an oval shape and can not create a linear effect. Cheek implants that can dose have to be special designed to replicate much more closely the natural bone anatomy of the entire zygomatic bone. I call this a ‘cheek-arch’ implant style. It can be seen with this shape is laid on the bone that it replicates the natural anatomy and provides a lateral extension of it.

The difference between a cheek-arch implant style and standard cheek implants can be appreciated when one is overlaid on another. Its effect is a function of surface area coverage and better matching the shape of the zygomatic bone. It has a unique three-legged shape which replicates the zygomatic arch posterior, the posterior maxillary buttress inferiorly and a small infraorbital extension anterior. This shape also helps immensely in placement as the anterior and inferior legs also act as orientation markers on the part of the implant which can be seen through the intraoral incision.

Dr. Barry Eppley

Indianapolis, Indiana

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