Prominent cheek area is important for a youthful appearance and facial symmetry. As part of the natural aging process cheeks become hollow and flat. Sunken cheeks can also be due inherited condition or illness. As we age we loss mid facial volume as the result of fat degeneration and bone absorption. Weakening of supportive connective tissues leads to soft tissue sagging and development of jowls and deep wrinkles between the nose and corner of the mouth (nasolabial folds). Cheek rejuvenation can balance facial features and harmonize the face. Depending on the specific condition augmentation of the underlying skeleton with implants, soft tissue augmentation with fat or fillers or midface lift can be performed to add or restore mid facial volume.
A midface-lift is most suitable for middle aged patients who were previously satisfied with their midface appearance, but have noted a drop of the cheek rather than loss of volume. Soft tissues may be augmented with injections of your own fat taken from other part of the body (usually abdomen or thighs) with a procedure called lipofilling or fat transfer. Depending on the individual the injected fat is reabsorbed to some degree, and multiple treatments may be necessary to achieve a satisfactory result. However it offers more versatility than implants in sculpturing, and it can also address some wrinkles. Injections of fillers are less invasive but not permanent. Hyaluronic acid can be used as a temporary way to see if you would be satisfied with implants or fat grafting. Since fat is your own tissue there is no chance for allergic reaction. Cheek implants are made of silicone or other non absorbable material. They are used for augmentation of the facial skeleton to correct signs of aging or inborn deformities. There is a small risk of shifting the position or infection. The procedure (either implant or fat grafting) is performed under general anesthesia or sedation and takes approximately one hour to complete.
The implants can be inserted through a small incision in the mouth (between the front teeth and the upper lip), or through an incision for correction of the lower eyelid. A tight fitting pocket is created for the implant, and the implant is secured with stitches to the bone. If placed on the cheek bone they are called malar implants, and implants placed below the cheek bone submalar implants. Numerous shapes and sizes of implants are available for the specific indication. The incision in the mouth is closed with resorbable sutures. Implants can also be inserted through the incision for face or forehead lift.
Cheek augmentation with fat transfer or implants is commonly performed together with face, forehead or neck lift or blepharoplasty.
Recovery depends on the individual factors and technique utilized. There can be some swelling and bruising. Light activities can be started the day after surgery, if no other procedure is performed at the same time. Patients can return to work in a week. Temporarily sensation to the cheeks can be lost. Pain controlling medications are usually needed for a few days. With intra oral incision, there is no visible scar, and with lower eyelid incision the scar can hardly be noticed.
Complications although rare are infection, postoperative bleeding, shifting of the implant or allergic reaction. Signs of infection are redness and tenderness or fever. Prior to surgery antibiotics are used to minimize the chance of infection. If it occurs and antibiotics are not enough the implant has to be removed and replaced later. Implant can be displaced due to injury, scaring or swelling. If seroma (collection of fluid) accumulates, it has to be evacuated with a small needle.