Cheek implants are a common form of facial augmentation but there are numerous anatomic misconceptions about them. The cheeks are not a pure bone or soft tissue structure. Rather it is an aesthetic term myjhayt connotes a midfacial area. While there is underlying bony support to the overlying cheek region called the zygoma or cheekbone, it does not comprise the entire aesthetic cheek region. It comprises the upper half of the aesthetic cheek region. The lower half consists of soft tissues such as subcutaneous fat, masseteric fascia and the buccal fat pad.
The long standing styles of cheek implants are for the traditional cheek augmentation areas which is as much soft tissue based as bone. This is why the shape of these cheek implants are more oval and their longitudinal shape is not intended to align or be positioned over the cheekbone. This implant location creates an apple cheek fullness which is a rounded anterior midface location. Very often these implants even end up over onto the maxilla (the intraoral placement approach lends itself to pocket ‘under dissection’) losing much of their effect collapsing onto the concave shape of the bone below.
Compared to traditional cheek augmentation some patients seek a high cheekbone look which is a more common request from men than women. What they really mean is they want the bony structure of the cheek augmented. When a person naturally has strong or high cheekbones it is because the zygomatic body and arch can clearly be seen through the soft tissues. (skeletonized) Thus a high cheekbone implant has a shape that mimics exactly the nearly flat or convex shape of the underlying bone. As a result the implant has a very longitudinal rather than an oval shape. To date no standard cheek implant can replicate this effect.
Patients that get the best results from high cheekbone implants have less full face where the effect can be more clearly seen. As a general no more than 4mms at the zygomatic body curve should be done in such faces. A very thin face may require considerably less. A fuller rounder face may need more …if even such a cheek augmentation procedure has a chance to produce a favorable outcome.
Besides having the right implant design to achieve the high cheekbone look, proper implant positioning over the bone is also of critical importance. This requires complete subperiosteal dissection out over the full length of the curved zygomatic arch from an intraoral approach, a dissection that is unknown to surgeons that have only performed standard cheek implants. This is also a dissection that is almost at a right angle from the intraoral point off access. Since this dissection is blind it its very easy to not develop the proper pocket length and/or getting the thin tail of the implant fully laid out and positioned symmetrically on both sides.
Dr. Barry Eppley
World-Renowned Plastic Surgeon