How Can I Fix Cheek Sagging After Cheek Implant Removal?

Q: Dr. Eppley, I had a question regarding cheek sagging/puffiness after cheek implant removal. I had my cheek implants removed after 2.5 months because I wasn’t happy with the look. I felt my soft tissue didn’t look chisled, and the implants didn’t look natural. Even when they were in, I noticed that my lower cheeks seemed fuller, despite there being no implant there. After getting them taken out I still feel that my lower cheeks, particularly near my nose, look fuller and bloated. It’s not so much that they’re sagging; it’s more that it’s just not tight and thin like it was before. 

I feel the reason for this is after the soft tissue was detached from the bone, it’s simply not reattaching the way it was before. So even though it may not be sagging, the area is still bloated. When I push down on it I feel like I can push down half an inch. Is there anything I can do about this? I’m basically just looking to tighten the skin to the way it was before. The whole thing is just extremely depressing for me, as I lost thousands of dollars and feel like I was permanently disfigured. Had I have known that it wasn’t a reversible procedure I don’t think would have ever done it. 

Are my concerns valid? Essentially, does it make sense for the soft tissues to be bloated as a result of them not reattaching to the bone? And will they ever reattach? And is there anything I can do to tighten it up again so my face is not so bottom heavy/bloated. Would soemthing like laser work? 

Furthermore, if there is a solution is it risky? I’ve gone though enough emotional and financial trauma that I don’t want to do it unless it’s a relatively straightforward fix.

A: Thank you for your inquiry and detailing your surgical history and postop cheek implant removal concerns to which I can say the following:

1) By definition placing cheek implants requires the disinsertion of the osteocutaneous ligaments to the cheeks. The implant then acts as a spacer lifting up the released tissues. (soft tissue float) If the implant is removed these ligaments do not reattach. In a facial structure like the cheeks, which is like being on the side of a cliff, the released and floated soft issues fall down. Thus your supposition of what you are feeling is anatomically correct.

2) If a male gets standard cheek implants, they are more likely than not to created that bloated facial look and not achieve a more chiseled look. That is because such standard cheek implant create anterior submalar fullness and are not design to create the high cheek bone look that many men desire. This requites custom implant designs to do so. The standard cheek implant styles are largely made for women not men.

3) While there are techniques to try and reattach the cheek soft tissues up higher and back into place, they are neither straightforward or have an assured outcome of doing so.

Dr. Barry Eppley

Indianapolis, Indiana