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 they 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.
View a comprehensive video of Dr. Niamtu explaining midface rejuvenation options and cheek implants
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
(See the video at the bottom of this page discussing implant size and selection)
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.
The patient to the left 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.
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Facial proportion is one of the key components of beauty. Look at the picture below. This was from a study done in Germany. A picture of a female was altered 25% in terms of proportions in each box. That means that the size, shape and spacing of the features changed. The images were then shown to 1,000 college students and they were asked to pick the most attractive picture. 100% of the people chose number 5 or 6. This shows the power of proper proportion to the overall perception of beauty.
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!
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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.
The patient below underwent cheek and chin implant surgery by Dr. Niamtu and no other treatment. This case is an excellent example of how small changes in facial proportion can make big differences in overall beauty.
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.
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.
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 with computer techniques and Dr. Niamtu was one of the first surgeons in the state to use this technology over 15 years ago.
Simultaneous rejuvenation of the lower eyelids and the cheeks is a winning combination.