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People with a narrow-appearing face have often a deficiency in the width of where the upper jaw and cheek meet, known as the cheek or malar complex. The most common and simple method to improve the amount of cheek that one has is to place a cheek implant. There are some patients who do not want a synthetic implant in their face and may ask if there are any other ways to have ‘more cheek’.

There is one bone-moving alternative. Like the reverse of the bone cut used to make the cheek area more narrower, the cheek can similarly be made wider. Rather than removing a wedge of bone when the cheek cut is made, a single cut is made and the cheek complex pushed out. Because moving the cheek bone out creates a bone gap, the separated edges of bone need to be held apart with a small plate and screws. It is thought best to fill this bone gap with some material but a bone graft is unappealing for a cosmetic procedure. Filling this gap with synthetic bone particles or blocks is one option. I actually prefer not to fill this bone gap at all with the exception of the very top area which can be felt on the outside of the face by the eye. A small piece of ceramic bone substitute can be wedged up high near the top of the bone gap. The rest of the bone gap will fill in and heal over time on its own.

The use of this cheek expansion technique is for a very small number of patients. Cheek expansion builds out the side of the cheek but will not bring it forward or add forward projection, which many patients need more than they do width. Having adequate cheek projection but with a narrow face is a very rare cosmetic problem. Furthermore, there are fewer still that want to go through an operation to correct it. For this reason, cheek bone expansion is an operation of more theoretical than practical significance.

Dr. Barry Eppley

Indianapolis, Indiana

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