One of the factors that can enhance facial attractiveness is having prominent cheekbones. Flat cheeks can give the face a lifeless and expressionless appearance, while increasing the volume of the cheeks can restore vitality and attractiveness. Cheek augmentation serves both aesthetic and rejuvenating purposes. Although many people have observed the results of cheek augmentation for aesthetic purposes in themselves or others, they may be less aware of its rejuvenating effects.
To explain this further, you’ve probably seen young women or men who have undergone cheek implants or filler injections. This is considered facial enhancement through cheek augmentation.
With age, two main changes occur in the cheeks: Firstly, the fatty tissue in the cheeks undergoes some atrophy, causing the cheeks to become smaller. Secondly, the facial tissues become lax, and the soft tissue on the cheeks shifts downward. The soft tissue on the cheeks and under the eyes migrates downward, causing not only irregularities under the eyes and smaller cheeks but also deepening of the nasolabial folds (smile lines). To correct this condition, cheek augmentation surgery and cheek implants, along with other similar methods, can be used.
Now let’s see how cheek augmentation can play a role in rejuvenation.
The goal of mid-face rejuvenation is to create a relatively smooth surface on the cheeks and under the eyes, eliminating irregularities that develop with age. Sometimes, to eliminate these irregularities, it is necessary to augment the areas below the cheeks in addition to the cheeks themselves, in order to correct the creases formed around the mouth (nasolabial folds).
Cheek augmentation involves altering two parts of the cheek tissue. In the first part, the hard tissue (skeleton) of the cheek is augmented, and in the second part, the soft tissue (covering the skeleton) is augmented. A combination of both methods can also be used, meaning both the skeleton and the soft tissue can be augmented.
Hard tissue augmentation is achieved using cheek implants. Cheek implant placement is often done through an incision made inside the mouth. However, sometimes the chosen implant design is such that it’s better to place it through incisions in the temples or lower eyelid. The patient’s preferences and the types of surgeries they require simultaneously also influence the decision.
This type of augmentation is performed using various techniques. The use of threads that act like fillers, injections of hyaluronic acid gels, and fat grafting are the primary methods for augmenting and volumizing the soft tissue of the cheek. In cases where the cheeks have lost volume and become smaller due to sagging facial tissue and the movement of cheek tissue towards the mouth, a facelift can be performed to augment them and restore the soft tissues to their original position.
1. Consider the prominence of the facial skeleton
2. Consider the thickness of the soft tissue over the facial skeleton
It’s important to note that when deciding to undergo cheek implant surgery, in addition to the above factors, which are very helpful, in some cases, cheek augmentation can be performed simultaneously with other cosmetic surgeries (such as a facelift or chin implant).
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Soft tissue cheek augmentation can be achieved through various techniques. The use of threads that act like fillers, injections of ready-made gels, and fat grafting are the primary methods for augmenting and volumizing the soft tissue of the cheek. Among all the methods of soft tissue cheek augmentation, only fat grafting is considered permanent.
Silicone implants are very easy to install, which is why many surgeons recommend them to patients. Silicone implants have good biocompatibility and are used more often in the cheeks than any other type of implant.
Fortunately, it has been observed that unlike silicone chin implants, bone resorption in the cheeks due to silicone implants is less common. The reason for this is probably the low pressure exerted by the implant on the cheekbones. Considering the availability and reasonable price of silicone cheek implants, silicone can currently be considered the first choice for cheek augmentation.
The second type of implant available in the Iranian market is the Medpore implant, which, due to its porous nature, has greater biocompatibility and is much more resistant to infection than other implants. However, most surgeons recommend silicone implants to patients for cheek augmentation.
There are other types of implants, such as Gore-Tex, which are not readily available in the Iranian market at present.
Cheek implants can vary not only in the materials they are made of but also in their shape and design. The different shapes of cheek implants can be divided into three main categories. Depending on the appearance of the face and the patient’s desires, different models from one of the following categories are recommended to patients.
This is a type of cheek implant designed to directly augment the cheekbone. It is placed directly on the most prominent part of the cheekbone.
This type of implant is designed to augment the lower cheekbone and mid-face. It is placed slightly lower than the malar implant. It is more useful in patients who have a small mid-face and lower cheek. This type of implant is more commonly used in men.
This implant is suitable when the goal is to simultaneously augment both the cheekbone and the tissue below the cheekbone. This is particularly suitable for some patients who are genetically predisposed to excessive facial thinness or underdevelopment of the mid-face (sometimes in combination with other facial volumizing procedures).
Note: Choosing the wrong implant shape can lead to dissatisfaction after surgery. Therefore, during the pre-operative consultation, in addition to the size of the implant, the patient should be evaluated by the cosmetic consultant and surgeon in terms of the shape of the implant that can meet their needs.
Although there are different methods for placing cheek implants (through the mouth, under the eye, or through the temples), cheek implants are most often placed through the mouth.
1. Buccal Fat Removal: In some cases, buccal fat removal can complement cheek implants. In individuals with thick soft tissue and excessive fat accumulation in the submalar region, facial attractiveness is reduced. In these individuals, buccal fat removal alone can, to some extent, make the cheeks appear more prominent.
2. Aging Effects: With age, the bones and muscles of the cheeks atrophy, and the prominent angles of the cheeks gradually disappear. When performing facial rejuvenation, it is essential to consider increasing the volume and creating angles in the mid-face, especially the cheeks.
3. Other Augmentation Methods: In addition to cheek implants, cheek augmentation and mid-face and under-eye rejuvenation can be achieved through methods such as gel injections or fat grafting.
4. Endoscopic Cheek Lift: Individuals with adequate cheek volume but sagging cheeks due to various reasons may benefit from an endoscopic cheek lift. Candidates for this procedure are often younger, seeking to enhance the appearance of the eye area, and are usually under 45 years old.
Placement of Cheek Implants
Initially, it was thought that implants placed through the mouth (such as chin implants, cheek implants, and jawline augmentation) carried a higher risk of infection compared to those placed through external incisions. However, further studies have shown that the risk of infection is very low and similar in both methods.
As with any cheek augmentation procedure (such as gel or fat injections), there is a risk of asymmetry after cheek implant surgery. In general, post-operative cheek asymmetries can be categorized into three types:
To prevent asymmetry caused by implant displacement, surgeons take precautions such as securing the implant to the bone using sutures or screws, which prevents the implant from shifting and causing post-operative asymmetry.
Another factor after cheek surgery is the failure to address pre-existing asymmetries. It’s important to note that most people have some degree of asymmetry in their cheeks, and this will not be corrected by cheek implant surgery. Patients may mistakenly believe that any asymmetry they notice after surgery is new.
Sometimes, post-operative swelling of the cheeks may be asymmetrical. In such cases, patients can be assured that the observed asymmetry will resolve on its own without any treatment.
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Based on the information provided above, we know that cheek implants primarily enhance the hard tissue of the face. Other methods for cheek augmentation include fat grafting, gel injections, and the use of lifting threads. These methods work by increasing the volume of the soft tissue of the cheeks.
In general, we can categorize post-operative cheek asymmetries into three types:
● Asymmetry due to implant displacement: It’s important to note that to achieve the greatest beauty and harmony in the face, it’s necessary to separate the imperfections of the soft tissue from those of the hard tissue. If we try to compensate for the imperfection of one by enhancing the other, we won’t achieve satisfactory results. Consider the following example:
Example 1: Imagine a man whose cheekbones are underdeveloped, as shown in the image below. Instead of using a cheek implant (i.e., enhancing the hard tissue), if we use fat grafting or fillers to enhance the soft tissue, although the individual may appear more attractive in a static pose, in dynamic situations such as smiling, the excess soft tissue will accumulate around and under the eyes, creating an unattractive appearance.
Explanation of the Issue:
This text essentially highlights the importance of considering both the hard and soft tissues of the face when planning cheek augmentation. It argues that simply focusing on enhancing one without addressing the other can lead to suboptimal results, especially in dynamic situations. The example of a man with underdeveloped cheekbones illustrates how over-filling the soft tissue can lead to unnatural-looking results.
Example 2: Consider a woman whose facial bones are well-developed, as shown in the image below, but who has lost soft tissue volume in her cheeks and submalar area due to excessive weight loss. Using implants for this person’s face may make her appearance more masculine, rough, and larger than normal.
You should be very careful when choosing a surgeon. There have been cases where improper placement of cheek implants has led to complications that required additional surgery to correct. You can watch the video below to hear Dr. Bayat explain this issue in more detail.
1. Individuals with flat or non-prominent cheekbones.
2. People who have experienced a loss of cheek volume (due to bone and fat atrophy) as a result of aging.
3.Those who have suffered significant trauma to the cheekbone.
Although cheek implant surgery is considered a safe procedure, like any other surgery, it can have potential complications. However, these complications can be prevented or treated with specific approaches.
These complications include pain, swelling, asymmetry due to implant displacement, pre-existing asymmetry, or asymmetrical swelling during the healing process.
Given the nature of the surgery and the post-operative conditions, it is essential to be aware of the specific post-operative care instructions. This will help you return to your normal life as quickly as possible and avoid specific complications related to the surgery. To this end, you will receive immediate post-operative support through the provision of care instructions and follow-up phone calls.
If the primary goal of cheek implants is to create symmetry, it’s best to avoid this procedure.
There are two main types: silicone and Medpor
Given the soft nature of cheek tissue, silicone implants are generally preferred for enhancing cheekbones.
Yes, depending on which part of the cheek needs to be enhanced, different types of cheek implants can be used.
Yes, cheek implants come in small, medium, and large sizes. The appropriate size is chosen based on the individual’s facial structure.
There is a possibility of infection after any surgery. However, the risk can be significantly reduced by taking antibiotics as prescribed
If the bony structure of the cheek has been reduced, cheek implants are a better option. However, if the soft tissues of the cheek have sagged, a cheek lift is more appropriate
Yes, if an evaluation reveals that in addition to sagging soft tissues, the bony structure of the cheek has also been reduced or was underdeveloped to begin with, both a cheek lift and cheek implant can be performed simultaneously.
No, cheek implants do not make eyes look smaller.
Here’s a more detailed explanation
The purpose of cheek implants is to correct underdeveloped or atrophied areas of the bone.
The incision for cheek implants is made inside the mouth.
No, cheek implant surgery requires general anesthesia or deep sedation.
Cheek lifts and temple lifts can be performed along with cheek implants.
Cheek implant surgery can be performed starting at age 18.
Swelling from cheek implants usually improves by 80% within two to three weeks after surgery.
All implants, whether silicone or Medpor, are fixed with titanium screws to prevent movement.
No, fat grafting or dermal fillers can also be used to enhance the cheeks.
Yes, dermal fillers can be used to enhance the cheeks non-surgically.
As long as there are no complications, cheek implants do not need to be replaced.
No, only Medpor implants can be shaped.
Yes, if the cheekbone is fractured due to a severe impact, the cheek implant may also be damaged.
Cheek implants do not correct facial asymmetry, but dermal fillers can be used to address minor asymmetries.
