Infraorbital-Malar Implant

Q: Dr. Eppley, I’m inquiring about a cheekbone augmentation and possibly a bossing reduction. I’ve always been bothered by my side profile. To me, it looks more flat (or even mildly concave) than convex. I was seen by a craniofacial specialist about this concern, and he stated that my forehead shape and slope were fine, but I had very flat cheekbones and that it could be fixed. I’m not certain why I didn’t speak about a cheek augmentation procedure at the time.

I was wondering if a cheek augmentation, possibly a frontal bossing reduction, would help give the impression or a more convex profile. I’ve attached images. It may be hard to see in the images, but the areas under my eyes are completely flat, and vertical.

A: Thank you for your inquiry and sending your pictures. I would say that you are correct about your facial profile in regard to the lack of midface (cheek) projection and some frontal bossing protrusion. On a practical basis for a man, it is easier to undergo cheek augmentation than upper forehead reduction because of the incisional access and the resultant scar line.

Your cheek deficiency is really a more infraorbital-malar deficiency that encompasses from under the eye out to the sides of the cheeks. This is why you have a negative vector. (the cornea of the eye sticks out further horizontally than the projection of the cheeks.

This is not ideally treated by a standard cheek implant as this will provide no improvement to the under the eye area. This is best treated by a custom infraorbital-malar implant style.