Cheek Implants: small surgery, big changes

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Providing patients with a natural rejuvenation requires a firm understanding by the surgeon and the patient of all the areas of the face.  Brow and forehead lift are common surgical procedures used to improve the upper face.  Facelift and liposuction are used to rejuvenate the lower face.  Botox and fillers are used to enhance both the upper and lower face.  On huge problem that exists, even with experienced surgeons, is that the midface is often overlooked when performing facial rejuvenation.  Because of this, many patients end up looking tighter but not younger. The youthful face has abundant volume (fat) and it is in the right places.  It is also oval due to having more volume in the cheeks and a tight jaw line and neck.  With aging, we lose the oval shape and when the cheeks droop, the jowls form and the tissue around the jaw and neck sag, the face takes on a square appearance.  As we age, we go through a process of deflation (like the grape to the raisin) and we lose the good fat.  The youthful cheek fat (malar fat pads) undergoes atrophy and due to multiple causes sags into the lower face and becomes the jowls.  This leaves a hollow and gaunt appearance that is a common sign of middle age.  If you are over 40 years old, the chances are that you have lost some of your youthful midface volume.  Look in a mirror and smile.  Most of us look younger when we smile because we are artificially elevating our sagging tissues.  Smiling produces facial volume.  If you smile and hold your cheeks up, then relax your smile and let go of your cheeks, you will notice that elevated cheeks sink into the jowls of the lower face when you relax your smile. The above illustration shows that in order to look younger, we need volume in the midface.  There are numerous ways to augment the midface including midface lifting procedures, injectable fillers and cheek implants.  While all of these procedures are useful, cheek implants have numerous advantages.  First of all, they are permanent.  Since they sit under the deep tissue over the bone (periosteum) there is no where for them to go and the will sit in their original position for years.  This is especially true if they are secured with a micro fixation screw.  Midface lifts will sooner or later fall and injectable fat or fillers will sooner or latter dissolve.  Cheek implants will stay where they are placed!  Another huge advantage is that they are totally reversible.  It only takes about 10 minutes per side to place cheek implants and if the patient is unhappy with them, they can be removed with local anesthesia in several minutes.  Having the ability to reverse a procedure is a very big advantage and an unusual one in cosmetic facial surgery. Contemporary cheek implants (www.implantech.com) come in a vast array of sizes and shapes to give the surgeon and the patient many options in augmentation.  In fact there are so many possible choices of implants, it can become confusing.  In my practice, I use hundreds of facial implants.  I place them as a solitary procedure in younger patients and in conjunction with facelift and other procedures on a routine basis.  In reality, probably 80% of my cosmetic surgery patients are candidates for midface implants.  Getting the patient to realize this is sometimes difficult. To simplify the choice of cheek implants, I utilize three main implants.  The submalar implant is my most common choice.  This implant is designed to fill in the hollow area in the front of the face.  The submalar area is under the eye and the cheekbone.  If you look around, most people over 40 have some deficiency in this area.  These patients usually have normal cheek bones, but the area below them is hollow.  The submalar cheek implant fills out the deflated face without adding bulk to the cheekbones. The malar shell implant looks like a small calm shell and is used to produce the high cheekbone look.  This implant is designed for patients that have adequate fill in the submalar area but require more augmentation in the cheekbones on the side of the face.  This used to be a popular choice, but the over done, too high cheekbones look is out of style.  I personally only use the malar shell implant on patients that lack adequate fill in the cheekbone areas.  These patients require augmentation on the high portion and the side of the upper face. The second most common cheek implant that I use is the combined submalar shell implant.  This implant is basically a combination of the above two implants.  It provides the lower facial fill (like the submalar implant) but also provides augmentation on the cheek bones like the malar shell.  This implant is used on patients that either have developmental (hereditary) midfacial deficiency, or on patients that, through aging, have atrophy in this region. Cheek implants are placed through a ½ inch incision, inside the mouth, just above the eye tooth.  The implants can be placed with local anesthesia or light IV sedation.  The tissues over the cheek and cheek bone are lifted and the implant is placed on the cheek bone.  The implant is sometimes held in place with a micro fixation screw or a suture.  The entire procedure takes about 10 minutes on each side.  The patient will experience swelling, mild discomfort, and possibly temporary numbness for about 4-5 days.  Most patients are back to normal in about a week. Cheek implants are a great example of minimally invasive cosmetic facial surgery and also an example of a small procedure that can make a big difference.  In younger patients, those in their late 30’s and early 40’s,placing cheek implants as a solitary procedure can provide youthful reshaping of the midface.  The beautiful thing about this is that the change is a very subtle facial lift and although the patient looks better, no on can put their finger on why.  These implants provide a very natural look. To find out more about midface augmentation and cheek implants, click on www.lovethatface.com/cosmetic_facial_surgery_richmond_va/cheek_implant..html Joseph Niamtu, III DMD, FAACSCosmetic Facial Surgery