Other associated terms: submalar augmentation and malar augmentation (medical terminology)
Overview:
Cheek augmentation is a cosmetic surgical procedure that is intended to emphasize the cheeks on a person’s face. To augment the cheeks, a plastic surgeon may place a solid implant over the cheekbone or use filler injections with the patients’ own fat or soft-tissue fillers, like Restylane®, are also popular. Rarely, various cuts to the zygomatic bone (cheekbone) may also be performed.
Cheek augmentation is commonly combined with other procedures, such as a face lift, nose job (rhinoplasty), neck liposuction or chin augmentation. The cheek augmentation, itself, is a relatively minor procedure that restructures the cheekbone area, balancing facial features and restoring a youthful appearance – which can increase self-esteem.
Benefits:
Cheek implants on older patients allow the face to have a fuller look, especially if the face looks sunken in, drawn, or aged. Younger women, that have flat cheekbones, may desire cheek implants to achieve a more fashionable look associated with those in the modeling industry.
Underdeveloped cheekbones can also make other facial features appear more prominent which may create an undesirable facial balance. Another beneficial effect can also be to change theshape or size of the cheek in order to correct flaws caused by birth defects or injury.
Types of Cheek Augmentation:
The two main types of cheek augmentation are:
Facial implant surgery: This procedure uses a solid implant made of silicone, expanded polytetrafluoroethylene (ePTFE) or polyethylene.
Soft Tissue Facial Fillers: These are temporary, less invasive alternatives to solid implants and can include collagen and Restylane®
The final class of fillers comes directly from your own body, eliminating the chance of rejection. Once the material is taken from your body, it is tested and processed to remove any substance that could cause an allergic response or an infection.
The cost of these procedures and the length of effectiveness will vary. The more popular ones are Alloderm® (implanted), Fascian® (injected), and Cymetra® (an injectable form of Alloderm®)
Patient Characteristics:
Ideal candidates for cheek augmentation surgery are those who are in good health and are psychologically well-adjusted. As we age, some may lose fullness in the face, especially in the cheek area, as the result of lost soft tissue that can normally occur. The resulting sagging of the skin can also create wrinkles around the mouth. If this has happened to you, you may be a candidate for cheek augmentation.
However, this is not the only reason people seek cheek augmentation. A lack of fullness in the cheeks, that is not associated with age, can be addressed with cheek augmentation. Female patients commonly present with a desire to have ‘higher cheekbones’ to provide them with a more feminine look or who wish to have a more fashionable appearance.
These conditions typically reflect a deficiency in the underlying bony contour (facial skeleton).Also, those who have used soft tissue fillers to plump up their cheeks temporarily in the past, and were pleased with the results, may find that cheek implants offer a permanent solution.
Procedure (Cheek Implants):
Cheek augmentation is usually performed as an outpatient procedure that usually lasts for an hour or less. The surgery can be performed under general anesthesia or a local anesthetic with sedation and an epinephrine injection will be used to limit bruising. The surgeon makes a small incision inside the mouth (above the upper lip) and the implant is then inserted through the incision. It’s then positioned in place on or below the cheekbone. After the surgery, the patient is usually not released for another few hours, in order to give the anesthetic time to wear off.
After surgery, patients are fitted with protective bandages or a face wrap. The patient should expect bruising and swelling and the use of ice packs is recommended to help relieve excessive swelling or soreness.
Procedure (Facial Fillers):
The procedure for the application of facial fillers will depend on the product or material used and should be discussed with your doctor. But in general:
Fat Transfer:
Both the donor and recipient sites are cleansed and treated with a local anesthesia and the fat is withdrawn using a syringe with a needle or a cannula (the same instrument used in liposuction) that is attached to a suction device. The fat is then processed and injected into the recipient site with a needle. Sometimes a bandage is secured over the injection site.
Similar to collagen injections, “overfilling” is necessary since fat will be absorbed in the weeks following the injections. This may make the face appear puffy – but this will be a temporary condition and should not be alarming.
Non-biological Materials:
The doctor will mark the areas of application while you are in a half-sitting position. Cooling, with an ice pack is usually done to avoid ecchymosis (blood spot). The patient is left in a half-sitting or placed in a reclining position. The filler is then injected through the skin, into the areas to be treated, with a very fine needle. The non-injecting hand is used to assess the quality of the injection and to provide massage to the injected area. Patients, in general, experience minimal discomfort with the procedure lasting just several minutes. Patients are ready to leave the office soon after the procedure.
With facial fillers, the technique of the medical practitioner is very important in creating a natural lift. Medical practitioners will typically cross thread liquid augmentation products in the deep dermis or sub-dermal area of the cheek bone region of the face.
Depending upon the facial characteristics of the patient and personal preferences, physicians can give the cheeks a smooth curve or a more defined ‘apple-cheek’ effect. Patients desiring more of an apple-type cheek can ask for additional filler in the upper portion of the cheek bone area.
Recovery (Cheek Implants):
Recovery after cheek implants is similar to other major facial surgeries. After surgery, your vital signs will be monitored until the doctor is ready to release you. Most likely, you will experience discomfort and you may become confused as the anesthesia wears off. You may also feel a little nauseous from the anesthesia. Discomfort can be relieved with medication prescribed by your doctor. Emotional reactions are also possible based on your reaction to the anesthesia. You may also have chills that can be alleviated by requesting a warm blanket.
In general, discomfort can be alleviated through prescription medication. However, if you feel excessive pain once you get home, you should immediately call your surgeon or the on-call clinic support team. You will need to have someone drive you home and, if you live alone, you may want to arrange for someone to stay with you for the first night following surgery.
Once you’re home, you need to keep the incision and sutures clean and dry. Moisture from any liquids or creams can lead to inflammation or infection. Additional care instructions will be given, regarding your sutures, Steri-strip® applications or surgical glue. For intra-oral incisions, you will be instructed to keep your mouth clean. This can be accomplished using an antiseptic mouthwash throughout the day. Your diet will also be restricted and you will most likely be put on a liquid diet until the incisions are healed. Touching any incision line (for applying medications), will require the use of a clean latex or vinyl-gloved finger.
Take your body temperature regularly and often, as an elevated temperature may be an indication of infection. Take your antibiotics on schedule until they are finished. Please note that some antibiotics can render birth control pills ineffective. The doctor will prescribe pain medications that you should take regularly in order to ease discomfort. Swelling will also occur, during your recovery period, for up to 3 to 5 months.However, this could be minor.
Bruises will also be present – the severity depending on the patient’s physiology. Cold compresses can be used to alleviate this. You need to be careful regarding damage to the surgery site and getting the incision line wet. You can start using warm compresses for this purpose, 48 hours after surgery.
You will need to be elevated during sleep. A recliner works well for this – or you can use 2-3 pillows under your back and head. This reduces pain and swelling. Even though you may feel extra tired, your surgeon will advise you to walk around as soon as you are able in order to remove the risk of blood clots. But no exercise or strenuous activity will be allowed for at least 3 weeks. Be aware that anything that causes an elevation in blood pressure can cause bleeding.
There may be numbness, at first, during your recovery period, caused by swelling. This usually goes away within a few weeks but, in rare cases, the loss of sensation may be permanent. You may also experience unusual sensations that can include sharp pains, burning or tingling that may emanate from the nerves as they begin to function again.
Recovery after cheek implants can be a little boring and/or tedious, as with any surgery done in or around the mouth and face (especially the pain, when you’re eating), but the results can make up for that.
Recovery (Facial Fillers):
Generally, there is no recovery period necessary when you undergo dermal fillers. However, some effects from the procedure may need to be monitored – such as redness, swelling and bruising which is normal and will subside. You will be provided with a list of instructions to follow, to help avoid complications and provide for quality results. These instructions will include: hygiene, care for injection sites, medications to avoid and the types of facial movements to perform or avoid on the day of the procedure. At the most, you may wish to take the day off from work.
Risks Associated With Cheek Augmentation Surgery:
The risks associated with cheek augmentation surgery, like all other cosmetic surgeries, are placed into two basic categories. First, there are the standard surgical risks that accompany any surgical procedure. Secondly, there are risks that are unique to a particular procedure.
Standard surgical risks include bruising, swelling, bleeding, scarring, infection, numbness and a permanent loss of sensation in the area where the surgery was done.
For the unique risks involved when it comes to cheek implants, the greatest risk is that the patient will not be pleased with the results (which is rare) and the concern that the facial implant will shift its position which will necessitate a second operation. There are some precautions that must be exercised following surgery which can help reduce some potential risks.
For example, chewing is limited immediately following surgery and a soft food diet is required for several days. Sports that involve physical contact should be avoided as well as pressure to the cheek or strenuous activity.
As mentioned earlier, you should have someone else drive you home on the day of the surgery. If you live alone, you should arrange to have somebody stay with you, at least for the first night that you arrive home. Make sure to wear loose clothing that does not have to be pulled over your face. As with all surgeries, if you are a smoker, your surgeon may ask you to quit smoking for a time before and after the surgery. For anesthesia purposes, you should ask your surgeon if you may eat or drink the night before the surgery.
Procedure Costs:
The specific cost of cheek implant procedures differs between surgeons, and the average cost of cheek implants differs between geographic regions. The fee for the cheek surgery itself varies, but generally ranges from $2,000 to $3,000. However, lab fees for blood tests, x-rays, anesthesia, facility fees and other associated costs must also be considered. Depending on the surgeon and the related medical fees, cheek augmentation cost can average from $2,400 to $5,000. However, the cost of cheek implants may be greatly reduced if the procedure is done in conjunction with another facial plastic surgery procedure.
Facial filler procedures vary widely, as do the costs of the procedure. Examples are:
Bovine Collagen: Location for the surgery is usually in the office. There is also a need for a skin test, since most people are allergic to bovine collagen The time required for the procedure is 5 to 15 minutes and can be done with or without anesthetic or nerve block The effects last 2-4 months and the average cost is $200 to $400 – making it the least expensive alternative.
Restylane® and Perlane®: Location for the surgery is usually in the office. There is no need for a skin test since both products are made from hyaluronic acid which is a natural substance that creates volume in the skin. The time required for the procedure is 5 to 15 minutes and can be done using a nerve block, topical cream anesthetic or a freon spray (cold) to numb the injected area along with injected local anesthetic or sedative drugs. The effects last 12 months and the average cost is $500 to $1000 per treatment.
Fat Transfer: Location for the surgery is usually in the office. There is no need for a skin test, since the patient’s own fat is used and the time required for the procedure is 5 to 15 minutes. A local anesthetic is used and side effects can include some swelling, bruising or redness in both the donor and recipient sites. You will need to stay out of direct sunlight until the redness and bruising subsides - usually about 48 hours. The effects last from several months to forever. Repeated injections may or may not be necessary. The average cost is $2000 to $4500 per treatment.
Things to Discuss with Your Surgeon During Your Consultation:
10 Questions to Ask Your Doctor Regarding Cheek Augmentation:
• What are the realistic results that I can expect from the surgery?
• Where will the surgery be performed and is the facility accredited?
• What type of implant is recommended and why?
• What is the total cost of the procedure (and any follow up)?
• What are the risks involved with cheek augmentation surgery?
• How often do complications occur in this practice (percentage of patients)?
• What is the policy regarding the repair of the surgery if the procedure does not adhere to agreed upon standards?
• How experienced is the surgeon performing the procedure?
• What are my anesthesia options?
• Have you ever had your malpractice insurance coverage denied, revoked or suspended?