Cheek Implant Revision

Q: Dr. Eppley, I am interested in cheek implant revision. I had cheek implants put in in ten years ago by a local plastic surgeon.  I originally went to see him because I had puffy cheeks and I did not want that baby-face look, so he suggested putting in submalar-malar cheek implants. The look I was going for was not achieved as it made my face look more full instead of narrow like I told the doctor I wanted.

The left implant either shifted up or was not put in correctly which caused one side of my face to be uneven with the right.  There was also some type of nerve or muscle damage because my smile on the left side would droop down, almost like I had a stroke.  There is still a little scar tissue that has formed around the implant.

I am considering the following options to achieve the look I’ve wanted from the beginning:

Option 1:

Slightly lower the left implant so it looks even and contoured to my face, like the other side.  Have some of the fullness in my cheeks taken out by removing the fat.

Option 2:

Remove the implants and have the fat removed from the cheek area.

Option 3:

Have new implants put in and have the fat removed from the cheek area.

I know option 3 will most likely be out of range for me to afford, and option 2 will most likely leave my face looking flat and my skin sagging where the implants were.

A: Thank you for your inquiry regarding cheek implant revision  and sending your pictures of concerns. First, the concept of putting in combined malar-submalat cheek implants was never going to make your face more narrow or sculpted. They are a cheek implant style that will give you an ‘apple cheek’ effect, an area of midface augmentation that appeals to some women but very few men in my experience. Second, cheek implant asymmetry is very common as the placement of any two-sided implants in the face or body is very difficult to achieve perfect symmetry particularly through the limited access of an intraoral incision.

That being said, my comments as to your listed options:

1) While cheek implant adjustment can be done, these existing implant styles do not appear to be achieving your initial objectives. Thus adjusting the left cheek implant may improve their symmetry but would not may the overall desired look any better. Whether taking out the buccal fat would be helpful remains to be seen. This is an approach that offers the simplest and least risky choice but also one that has the least aesthetic gain.

2) Without some cheek prominence removing buccal fat would provide little if any aesthetic improvement.

3) This would offer the best chance for real change and to get you closer to your aesthetic midface goals. The key is the cheek implant styles…which was the same important issue prior to your first surgery.

Since you mentioned cost, Option #1 would definitely in my option be better than Option #2.

There is also an Option #4. Treat both existing cheek implants (as well as adjust the left cheek implant and the buccal lipectomies) by getting rid of the submalar portion of the implants which is not helping your facial aesthetic goals.

Dr. Barry Eppley
Indianapolis, Indiana