Cheek Implants

Q: Dr. Eppley, I want to get cheek implants, a sliding genioplasty and jaw angle reduction.My question is that I have just had maxilla advancement jaw surgery (LeFort 1 osteotomy) one months ago. Only the maxilla was moved forward. The mandible was not moved. How long is necessary to wait before I can come see you to get these surgery procedures done? I worry the maxilla may be banged in the surgery or after 4 weeks is this not a problem?

A: Since you just had a LeFort 1 osteotomy just four weeks ago, I would wait a full 8 weeks before doing any surgery that would involve re-entering the surgical site (cheek implants) This is not because the maxilla has any change to be displaced. (it is undoubtably rigidly secured into place with plates and screws) but because you want all the swelling to get out of the cheeks so you have a good idea when placing cheek implants so that the style and size of the implants could be best judged. As it relates to the mandibular procedures (sliding genioplasty and jaw angle reduction) the previous LeFort 1 osteotomy has no impact on their execution and vice versa. But waiting until all facial swelling has resolved is still worthy of the wait.

Dr. Barry Eppley

Indianapolis, Indiana

Zygomatic Arch Augmentation

Q: Dr. Eppley, I’m wondering how augmentation of the zygomatic arch is done. Is it possible and is it safe to do? It seems that it would not be much different than getting cheek implants.

A: Zygomatic arch augmentation is permanently done by placing an implant from inside the mouth, very much like a cheek implant. (only further back to the temporal bone in front of the ear. This is easiest and most consistently done using a remade implant as opposed to filler, fat or any other type of material injections. Zygomatic arch augmentation can be done alone or in conjunction with the cheek as an extended cheek implant. It is ideally done using a custom made implant for an exacting fit but in some cases may be able to be done using a ‘semi-custom’ approach. (semi-custom means using a custom zygomatic arch design already created for another patient) There is not that much variation in the shape or curve of the zygomatic arch amongst most people.  As you may know there is no specific zygomatic arch implant available off the shelf or premade. So zygomatic arch augmentation must be done by making the implants for each patient. (custom vs semi-custom)

Dr. Barry Eppley
Indianapolis, Indiana

Cheek Implant Replacements

Q: Dr. Eppley, I am interested in cheek implant replacements. I had cheek implants placed two years ago. As a result, my cheeks are uneven and prominent in the wrong place. I want high cheekbones and also the uneveness of the current submalars makes one cheek look higher and more prominent and throws my jawline off making it look wider on one side. I want to correct this and obtain higher cheekbones instead of the cartoon character look. That’s why I want to swap them out for other cheek implants, either malars only or combo implants. Can you look at my pictures and give your recommendation?

A: Thank you for sending your pictures and questions about cheek implant replacements. It is very clear that the large submalar cheek implants is really not the right cheek implant style for you. It creates too much fullneess below the cheek bone which does not work well in your face. I would recommend the following:

1) Remove existing submalar cheek implants.

2) Your new cheek implant style would be any form of a combo or one that has no submalar component at all.

3) You need ‘high’ malar augmentation style implants that also go back further onto the zygomatic arch. No such standard malar cheek implants exists, even amongst the standard malar options. Ideally a custom cheek implant style is made that would fit your face precisely and create the augmentation exactly where it is needed. Because your current implants have created loose cheek tissues, the new cheek implants really need to help lift up this tissue.

4) If I was ‘forced’ to use a standard cheek implant I would use the malar shell style and modify it during surgery.

5) I would consider doing subtotal buccal lipectomies and perioral mound liposuction to contour in the area below the new higher malar augmentation to maximize the effect.

Dr. Barry Eppley
Indianapolis, Indiana

Cheek Implants

Q: Dr. Eppley, I had cheek implants placed two years ago. As a result, my cheeks are uneven and prominent in the wrong place. I want high cheekbones and also the uneveness of the current submalars makes one cheek look higher and more prominent and throws my jawline off making it look wider on one side. I want to correct this and obtain higher cheekbones instead of the cartoon character look. That’s why I want to swap them out for other cheek implants, either malars only or combo implants. Can you look at my pictures and give your recommendation?

A: Thank you for sending your pictures. It is very clear that the large submalar cheek implants is really not the right cheek implant style for you. It creates too much fullness below the cheek bone which does not work well in your face. I would recommend the following:

1) Remove existing submalar cheek implants.

2) Your new cheek implant style would be any form of a combo or one that has any submalar component at all.

3) You need ‘high’ malaria augmentation  styles implant that also go back further onto the zygomatiuc arch. No such standard malar cheek implants exists, even amongst the standard malaria options. Ideally a custom cheek implant style is made that would fir your face precisely and create the augmentation exactly where it is needed. because your current implants have created loose cheek tissues, the new cheek implants really need to help lift up this tissue.

4) If I was ‘forced’ to use a standard cheek implant I would the malar shell style and modify it during surgery.

5) I would consider doing subtotal buccal lipectomies and perioral mound liposuction to contour in the area below the new higher malar augmentation to maximize the effect.

Dr. Barry Eppley
Indianapolis, Indiana

Jaw Angle Implants

Q: Dr. Eppley, I am interested in jaw angle implants and cheek implants. I’m 31 years old  and I’ve always felt my cheeks and jawline have been a bit “soft” and chubby despite me being rather skinny, so I was hoping you could give me your opinion. I’ve attached a couple images to the post but I’ve also uploaded a file here which includes multiple angles of my face: I wanted to discuss whether surgery might be appropriate on the following areas, given I’m not at all overweight and I don’t think I could address them via weight loss:

1) You can see there is some fat under my chin towards the back of my neck in the first picture when the camera is tilted upwards (I’m 6’1″ tall so it’s fairly visible in everyday life).

2) You can see from the side views that my jawline is quite “soft” and not well defined in general, particularly towards the back.

3) What I assume is the jowl area (labelled in red on one of the images) also seems quite “chubby” and both hangs down below my jawline and makes my lower face wider and less defined than it would otherwise be. There’s also a pre-jowl “hole” in my jawline in the 3/4 view that may or may not be connected with this.

4) My cheek area as a whole just seems quite flat and undefined when seen from the front. There doesn’t seem to be much shape there, it’s kinda just a large empty space.

I’ve had a chin implant in the past (Implantech Anatomical Chin sized large) and I’m generally content with the new position of my chin, but I was told I had an underdeveloped jaw and I assume that is contributing to these issues. However, as the surgery to fix that issue is such a major undertaking I was hoping it would be possible to address these issues via other methods. 

I’m curious as to whether these issues are caused by excess fat or by skeletal deficiency? Would liposuction be a good idea? Are cheek implants a possibility to give my cheeks a bit more structure?

I had cheek implants placed roughly 18 months ago, but I had them removed again 6 months ago as I felt they made my face too wide (and a little feminine), particularly when I was smiling. However, we never really discussed the different areas of the cheek that could be enhanced via an implant before the surgery, so I’m unsure if I was unsuitable for implants in general or if the type of implant was simply poorly chosen.

Thanks for your time and apologies for the long email!

A: Thank you for your inquiry and sending your pictures. For our jawline, I think the fundamental problem is that of skeletal deficiency. By your own admission you had a naturally shorter and underdeveloped jawline that ideally should be treated by orthognathic surgery. But, understandably, you do not want to purse that amount of effort. The chin implant has now provided adequate anterior jawline projection but the rest of the jawline behind it remains deficient and actually now has become more apparent with the chin being corrected. Your jaw angles are high and deficient. This creates a relative soft tissue excess/looseness. While liposuction can be done around the jaw angles and along the jawline, it is not really going to reshape these areas. This is an issue of volume deficiency particularly at the jaw angles. Either preformed or custom jaw angle implants are what you really need to complete the total jawline augmentation effect.

Since you have had cheek implants that were not successful, any reconsideration of them should be done more thoughtfully. I would need to see before and after pictures of your initial cheek implant results and to know exactly what style and size of cheek implants that were used. It is certainly true that a cheek implant is not just a cheek implant. There are different styles of cheek implants and, in my experience, most of the available cheek implant styles are not really made for men. (just like most chin implants do not really work well for most women)

Dr. Barry Eppley

Indianapolis, Indiana

Facial Implants

Q: Dr. Eppley, I have a few questions about faclal implants. Can cheek implants be done with local or non general anesthesia? Also I have a short face and need to add lateral width and height but I worry about the big wrap around jaw implants involving the masseter muscle. So can we do a custom chin implant with wide wings extending laterally and vertically as far back posteriorly as possible but not hitting the masseter muscle. I realize there would be a major step off somewhere further down the jaw and the rest all the way around the ramus I would fill in with fat or radiesse. Also could that be done without general anesthesia too?

A: In regards to facial implants, certainly cheek and an extended chin implant can be done under IV sedation or MAC. (monitored anesthesia care) The use of local anesthesia for most facial implants alone would likely be inadequate and that would be doubly true if both cheek and chin implants are done at the same time. Be aware that the use of local or IV sedation does not save any money as the intraoperative time to do facial implants takes twice as long as when done under general anesthesia. So your motivation for the selection of anesthesia for these facial implant surgeries should not be one of saving money.

Dr. Barry Eppley

Indianapolis, Indiana

Cheek Implants

Q: Dr. Eppley, I have had so much filler, including volume (five vials of Sculptra and Juvederm within the past year) and I still feel that my cheeks are not full enough. I had very high cheek bones when younger and I am now 52 years old. I used to do the IPL laser years ago and this thinned my face very much due to fat loss. I would like to have a consistently full face rather than be dependent on these costly fillers. When I do the filler the swelling makes me look fantastic, but once the swelling is over it is deflation all the way. I thought that cheek implants, even the smallest, would give me a foundation that I could be happy with. 

A: injectable fillers play a major role in facial voluminization, particularly in the cheek area. But the reality is that it is not a long-term solution to one’s desire for fuller cheeks. Fillers are great long enough until one’s decides that they either want to ‘graduate’ to more permanent solutions or to stop their cheek augmentation efforts. While fat injections are one of the two more permanent options, cheek implants provide an assured method of permanent cheek augmentation. With the wide variety of cheek implants style and sizes, patients and plastic surgeons have a lot of good options to choose from for permanent cheek augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

Cheekbone Reduction

Q: Dr. Eppley, I have rather under defined but wide cheeks. I’m interested in undergoing both Cheekbone Reduction and Cheek Implant surgeries. I saw your answers on RealSelf and wanted to know more about your experiences in these surgeries. Also, how much would it cost to perform both surgeries? Thank you a lot in advance.

A: You have the classic wide cheekbones (technically zygomatic arches) that do not have much anterior projection over the body of the zygoma. (malar prominence) Hence your description of ‘underdefined but wide cheeks’. As you already know improving this type of cheekbone anatomy requires cheekbone reduction surgery (technically inward respositioning of the zygomatic arches) and implant augmentation. (anterior cheek augmentation) The most challenging aspect of this surgery is in the cheek implant design. There is no standard cheek implant made that achieves the type of cheek augmentation that you need. Fortunately I have treated enough Asian patients who desire this exact type of cheek change that I have designed specific cheek implants to achieve this anterior projection but which create no lateral projection or width increase.

I will have my assistant pass along the cost of the surgery to you on Monday.

Dr. Barry Eppley

Indianapolis, Indiana

Cheek Implants

Q: Dr. Eppley, I have had injectable fillers in my cheeks with injections of several popular products over the course of three years now. It is costing a fortune since I metabolize it quickly. (so I’ve been told) I have used Radiesse, Juvederm, and most recently Voluma and love the results for correcting diagonal mid cheek lines and loss of fullness but they do not last more than 4 months. How do I find a surgeon who has sufficient experience in cheek implants ? What is cheek implant surgery downtime? Longevity? Any other cheek augmentation alternatives?

A: Your injectable filler story is not uncommon and many patients will be in your same situation in the years ahead. Injectable fillers are great at doing what they are intended to do most of the time. But despite the good results they provide, many patients have or will find out that the long-term costs of injectable filler ‘maintenance’ will become prohibitive for some patients. Thus seeking a permanent cheek augmentation solution has merits.

Cheek implants can provide a very satisfactory solution provided the proper implant style and size is chosen. Because the cheek area and the cheek implants chosen to augment it defy any exact method of measurement (unlike chin implants for example where the amount of horizontal augmentation needed can be measured) it takes a surgeon with a lot of cheek augmentation experience to get it right the first time. While the concept of cheek implants is simple, it can be difficult to get their placement anatomically correct with good symmetry. This difficulty is imposed on top of how to select the best cheek implant style and size for the patient.

Cheek implant recovery is largely about facial swelling and the time it takes for it to look acceptable. In reality expect that to be longer than one really wants. It takes about ten days to look socially acceptable, three weeks to ‘normal’ and really three months to judge the final result and how one feels about the facial change.

The intermediate step between injectable fillers and implants for cheek augmentation is fat injections. While far simpler and with a very quick recovery compared to cheek implants its issue is how well the fat will survive and how long it will persist. These are unpredictable and can be different for each patient.

Dr. Barry Eppley

Indianapolis, Indiana

Cheek Lift

Q: Dr. Eppley, what is the difference between the effects of cheek implants and a cheek lift? In looking at pictures cheek implants looked more subtle than the lifting of the  cheek tissues. The cheek implants themselves looked more obvious than the cheek lift, however. The cheek lift appears to pull on the face and make the nose a bit wider and even lift the lip. So the overall change to other facial features with implants seemssubtle while there were more changes to other facial features with the cheek lift,despite the cheeks themselves looking more natural. Am I correct in this assessment?

A: You are quite accurate in your assessment of the influence of the cheek lift vs cheek implants and their effects on the face. Cheek implants push the tissues more out and forward while a cheek lift pulls the tissues more up and back. Thus their effects on the cheeks are different. A cheek lift can widen the nose and pull upward on the lips. Conversely cheek implants have no effect on the nose and the lips.

This is why a cheek lift often creates a bigger change on one’s face while cheek implants have a isolated effect on just the cheeks.

Dr. Barry Eppley

Indianapolis, Indiana