Cheek Implants

In the past, cosmetic surgeons concentrated on making patients look tighter, not necessarily younger. Contemporary cosmetic surgeons appreciate the importance of volume in facial aging and rejuvenation. Today's surgeons utilize many options including injectable fillers, fat transfer, lifting procedures and midface (cheek) implants to restore volume.

Cheek implants have numerous advantages over other methods of restoring midface volume.  Fillers and fat will dissolve over time.  Fat and permanent fillers will droop over time, worsening the problem and cheek or midface lifting procedures will sag over time.  Cheek implants are fixed to the cheek bones with tiny micro screws, so the will always remain in place and not droop.  This makes them the only three dimensional method of cheek rejuvenation that is permanent and won't move.  Perhaps the biggest advantage is that if the patient does not like them, they can be removed in 5 minutes! There are not many options that are both permanent and reversible.  When considering the available options for midface rejuvenation (fillers, fat, lifting procedures and implants) nothing rivals the versatility of silicone cheek implants.

One thing that has never ceased to amaze me is how many surgeons will perform cosmetic facial rejuvenation on the upper face and lower face and completely ignore the midface.  A volumized midface is the hallmark of youthfulness and contemporary cosmetic facial surgeons realize this fact and address this important area.

Click on image below to view a 5 minute video of Dr. Niamtu explaining midface rejuvenation options and cheek implants

Facial Aging

Young people have positive fat distribution in the face that contributes to a "young" look. As we age, this fat atrophies and sags and produces a hollow and aged appearance.

Aging is a process of deflation and as the youthful midface fat changes position, we look drawn and aged. Young people have adequate midface fat.

The above illustration shows how the facial fat pad changes shape and position as we age. Midface implants can reverse these changes.

Cheek implants are a small procedure that can deliver big improvements. They are frequently used with other rejuvenation procedures such as facelift, eyelid and brow surgery, laser resurfacing, etc. When used with other procedures, the main procedures are the "cake" and the cheek implants are the "icing". Cheek implants can also be used as a solitary procedure as they add youthful volume to the face.

To illustrate the importance of cheek implants, look in the mirror and smile. Most of us look better and younger when we smile because we are elevating the sagging tissues to where they were in youth. While smiling, hold your cheeks up with your fingers and relax the smile. When you let go of the cheeks, they will droop to the jowl area. Restoring the midface volume makes us look younger for several reasons.

First of all, young people have volume in their cheeks; secondly the aging midface droops and makes the younger oval face appear square as we age. By replacing the volume in the midface, the face takes on a youthful oval shape. An additional means of seeing what you may look like with midfacial augmentation is to lie back and lift your chin while looking in mirror. The gravitational change allows the sagging cheek tissue to return to its normal position.

Lying back and tilting the chin forward can simulate midface augmentation and is a means of "previewing" what cheek implants may do.

Cheek Implant Frequently Asked Questions

Paper or Plastic?

I frequently get asked what material is the best for facial implants and my answer is usually silicone. Silicone rubber has been used in the body for decades and is in many medical and surgical devices. When silicone is placed over bone, it feels like bone. A big advantage is that since it is soft, it will conform to the underlying anatomy and never feel like a sharp edge. Perhaps the biggest advantage is that if a silicone implant needs removal or replacement, they are very serviceable.

Some implants are made from porous polyethylene and there are potentially significant problems with these implants if they need to be removed or replaced. Believe me when I say this because I have taken them out from patients from all over the world that were placed by other surgeons. These implants enable soft tissue growth and when removed can cause tissue loss and soft tissue defects. It is not uncommon to have connective tissue and muscle attached when removing them and some surgeons refuse to remove them because the risk of tissue and nerve damage. Another problem with the rigid implants is that they do not conform to the underlying tissue and it is not uncommon to feel a ledge or ridge. Having said this, these implants are OK if they integrate and don't need removal. In actuality, there are many materials that are suitable for implantation.

It is not my place to condemn any implant, I can only relate my personal experiences and those of respected colleagues. I have successfully used silicone for over 25 years and when fixating the implants with a microscrew, have had very little problems.

How Long Will My Implants Last?

This is a frequently asked question. The answer is decades, maybe forever. Since the implant is placed on the bone deep beneath the skin and usually secured with a single micro screw, it can't move anywhere. Unlike injectables, fat and lifting procedures, the cheek implants become a permanent part of your facial bones. Remember, although the result is extremely long lasting, the implants may be easily removed with local anesthesia at any time.

How Do I Know What Size to Use?

This is the art of facial implants and largely depends on the physicians experience. Dr. Niamtu spends significant time with facial implant patients assisting them in the selection of the proper implant. Besides listening to what the patient wants and accessing what the patient needs, there are also implant "try ins" that allow Dr. Niamtu to select the best fitting and shaped implant for each patient.

How Long does the Cheek Implant Procedure Take?

Cheek implants can be placed with local anesthesia alone or with IV sedation. The procedure takes about 15 minutes per side.

How Long is the Recovery?

The recovery for cheek implants varies but generally after several days most patients can return to light activity. Some patients will also return to work after 3-4 days. Recovery depends upon the amount of swelling that occurs with individual patients as some people swell more than others. In addition, the ability to smile and pucker will be slightly different for the first week to ten days. The average patient misses one week from work.

Can the Implants Move Around?

Dr. Niamtu secures the cheek implants with a tiny micro screw (no, it won't set off the metal detector at the airport!) to keep them in place. Failure to do this can lead to problems with result, infection and bone loss under the implant. By securing the implant these mobility related problems are eliminated.

Types of Facial Implants

The most common facial implants are used for chin and cheekbone enhancement. These implants are available in various materials but the vast majority of successful and FDA approved implants are made of surgical silicone. They feel natural and the infection or rejection rate is extremely low and silicone surgical implant material has been used for many surgical applications for decades.

Many types of facial implants exist for correction of cosmetic or reconstructive problems. These implants are anatomical which means that they are specifically designed to augment specific areas. Some implants augment the actual cheekbone area while others augment the area of the cheek under the eye. Many styles of cheek implants are available but the most common used are the following.

The submalar implant is designed to provide maximal augmentation on the sunken part of the cheek under the eye and to the side of the nose. This implant does little for cheek bone augmentation.

The malar shell (malar means cheek) implant is designed to augment the actual cheekbone area for patients that desire more fullness in this area.

The combined submalar implant augments the entire midface and is a combination of the submalar implant and the malar shell implant.

Submalar Implant, Malar Shell Implant and Combined Submalar Implant

Cheek Implant Surgical Procedure

Cheek implants are a relatively simple procedure that takes about 15 minutes per side and can be performed under local anesthesia or IV sedation. The surgery causes moderate swelling and the recovery is usually about a week. They are placed through a very small incision above the gums.

Submalar Implants

One of the simplest procedures for rejuvenating the midface is submalar implants. The submalar region is the area that is just below the lower rim of the eye and the cheek as shown in the following picture. The fat in this area begins to descend in the fourth decade and gives the face a drawn and hollow appearance. Although many patients think that "cheek bone implants" are what they need, this could actually make the situation worse. What is important is to fill up the void in the midface and not necessarily on the cheeks. This is the ideal indication for submalar implants. The implants are placed through tiny incisions inside the mouth just above the gum.

Click to enlarge

The above patient is an absolute example of the purpose of cheek implants.  This female patient underwent minifacelift, upper eyelid surgery and submalar implants. Although there is improvement from all procedures, it is the cheek implants that truly make her look younger. 

The picture above shows an actual submalar implant placed over the area that will be augmented. The implant is placed through the mouth.

Cheek and midface implants are placed through a small incision just above the gums.

This patient is shown 1 week after cheek implants, eyelid tuck and chemical face peel.  The average patient can return to work or play in about a week after cheek implants.

Find out more about chin and lower facial implants.

Custom Facial Implants

Custom facial implants are also available to fill in facial defects caused by disease, trauma or developmental problems. These implants are made withcomputer techniques and Dr. Niamtu was one of the first surgeons in the state to use this technology over 15 years ago.

We are not symmetric creatures!

One of the things that many patients do not realize is that almost every person has one side of the face that is smaller or larger than the other.  This is the rule rather than the exception in nature.  Most people have subtle asymmetries that are not readily noticeable but others have significant differences from one side to the other.

In the apiculture below, Dr. Niamtu is shown in a normal photo (B).  A mirror image of both right halves of his face (A) and both left halves (C) is shown.  Dr. Niamtu is left hand dominant and the mirror image of both left halves of the face make him look like an NFL linebacker while superimposing both right sides of the face in a mirror image makes him look more like an alien!

click to enlarge

This same photomanipulation can be performed on any person with similar results and it is important for patients to recognize this fact.  If a patient has a slight asymmetry before surgery, they are likely to have a similar one after surgery.  In some patients steps are taken to improve the disparity between sides. In patients with more noticeable asymmetries, Dr. Niamtu may elect to place a medium cheek implant on one side and a smaller on the other side or vice versa.

Implant Expertise

Dr. Niamtu is very involved with the use of facial implants and teaches other surgeons these techniques on an international basis. He has lectured to all cosmetic specialties including plastic surgeons, oculoplastic surgeons, dermatologists, facial plastic, ENT, oral and maxillofacial, here and abroad. Some of the multiple specialty lectures given by Dr. Niamtu are shown in the course brochures below. Click on any images below to enlarge.

The above brochure is from a plastic surgery course taught by plastic surgeon Dr. Ed Terino, facial plastic surgeon Dr. Bill Binder and Dr. Niamtu in Las Vegas. Click on the image to enlarge.

Drs. Niamtu, Terino and Binder shown at the cadaver instructional lab of
Touro University in Las Vegas.

The above brochure is from a facial plastic surgery course taught by facial plastic surgeons Drs. Binder, Tobias, Shire and Dr. Niamtu in New York City. Click on the image to enlarge.

The above brochure is from an oculoplastic surgery meeting in Cervia Italy where Dr. Niamtu lectured on facial implants. Click on the image to enlarge.

The above brochure is from a multispecialty cosmetic facial surgery course at the University of St. Louis in July of 2006. Click on the image to enlarge.

The above brochure is from a multispecialty cosmetic facial surgery course at the University of St. Louis in February of 2007. Click on the image to enlarge.

The above brochure is from a maxillofacial surgery cosmetic surgery course at Louisiana State University in New Orleans where Dr. Niamtu lectured on facial implants. Click on the image to enlarge.

Dr. Niamtu teaches four courses in Richmond, Virginia that are attended by cosmetic surgeons from plastics, facial plastics, Dermatology, ophthalmology, and maxillofacial surgery. Click on the image to enlarge.