How Can Volume Be Put Back in My Buccal Facial Areas?

Q: What are the options to put volume back to buccal area underneath the cheek bone? I am in my mid 30s.

A:  A buccal or submalar indentation or concavity can occur for a variety of reasons including a congenital facial concern  (developmental), after a buccal lipectomy (iatrogenic), or medication-induced. (retroviral drugs)  This area extends from underneath the prominence of the cheek bone down to the end of the nasolabial fold and out into the lateral face. In many patients the outline of this area resembles a triangle, hence its common referral as the submalar triangle.

The easiest approach for submalar facial augmentation is the injectable route. The most common agents used are the synthetic material Sculptra or your own fat. Sculptra was specifically developed for exactly this facial problem with its initial FDA-approval for facial lipoatrophy in the HIV patient. It is not permanent, however, and it requires a series of three injections a month apart to build up a result that may last up to 2 years. Fat injections are more of a surgical injectable method as they require a fat harvest which is then processed and injected into the submalar area. The fat of fat injections is not always consistent but the submalar does better than many other facially injected areas.

The other submalar augmentation method is the use of implants. A synthetic implant, known as a submalar implant, can be placed on the underside of the cheekbone to provide fullness to the upper submalar area. The other implant option is the use of a dermal-fat graft which can be placed into the buccal space. In a few cases, I have done a combination of a submalar implant with a dermal-fat graft to get a more complete submalar augmentation.

Dr. Barry Eppley

Indianapolis, Indiana