Your Questions

Q: Dr. Eppley, I have cheek implants placed and had an infection after surgery. It was drained and reclosed, that was three months ago. While some of the cheek swelling has gone down there is a noticeable asymmetry between the two sides of my face. I had  a CT scan done which shows no ongoing abscess and my doctor wants to do liposuction on the cheek to try and make the two sides more even. This does not quote make sense to me. Can you review the CT scan and tell me what you think.

A: I have received your CT scans and reviewed them in detail. While I would agree with the radiologist’s report that there is no obvious abscess/large fluid collection, the scan does show some significant asymmetry in the cheek implant positions and there is an encapsulated area around the left cheek implant with the infection history. You can see in the attached cropped images of your CT scans to what I am referring. Knowing that you did not have significant facial asymmetry before surgery and you had an infection of one cheek implant with secondary manipulation, your current significant facial asymmetry can not be explained by a fatty tissue problem. If you were my patient with these similar findings, the only course of action I would recommend is to re-explore the left cheek implant, remove any scar tissue and either reposition or just leave out the implant and let the tissues settle down. I would not rule out the possibility that this is a chronic inflammatory reaction from an originally infected implant. What you do know is the opposite right cheek implant reflects what it should look like. Thus the facial asymmetry on the left side is implant-related in some fashion. It would have to prove to me otherwise.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had all my stiches break open (only left side) 1 week after my cheek implant surgery so my left cheek got infected. I was in pain with swelling. The Dr .chose to do revisional surgery in his office where he took the implant out, sterilized it and flushed my cheek out with a liquid then put it back in and stitched it up again. I was on two antibiotics and right away the pain stopped and some swelling came down. My problem is that at 4 months out I noticed my cheeks were not matching up! From the top were the malar implant was put is fine but the bottom looks swollen on that problematic left side. The right side is thin and slender but the left looks like a ball especially when I smile. I talked to the Dr and all he offered was some lipo and acted like I always had that there. I know my face and it was never there before. My question is what test would you recomended to figure out why the tissue on one side of my face different from the other. The tissue is soft and squishy not hard. I’m worried this still has something to do with it being infected.

A: The two possibilitues are that this is excessive scar tissue that would commonly form after an infection. I doubt that it is an infection now since you know what that feels like. The other possibility is that the implant on the infected/revised left side is sitting lower or in a different position than that on the uncomplicated right side. I would suspect it is the latter and not the former. The definitive answer would be to get a 3D CT scan which would show the exact location and symmetry between the two cheek implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had cheek implants and fat grafting 3 weeks ago. The left implant is sitting too close to the lower eyelid and the end of the implant can be seen and felt at the end of the eye.  I have numbness in the upper lip and teeth. Is this normal? Implant was silicone and attached with screws.

A: Cheek implant asymmetry is not a rare problem. As the swelling subsides, usually about the three week time period after surgery, the position and symmetry of the implants becomes apparent. The most common form of cheek implant asymmetry is that one of the implants is sitting too high as evidenced by the lateral wing of the implant being palpable close to the corner of the eye. While it is something that you can tell now, the question is whether it is an aesthetic issue that ultimately you will want improved. If it is not seen or causes a visible lump, then it is an issue that most patients can live with. If the end of the implant is visible, you likely will wanted it adjusted for better symmetry. Intraoral placement of cheek implants almost always cause some temporary numbness of the infraorbital nerve with decreased feeling of the upper lip and teeth. This is a temporary issue, which is expected, and should resolve over the next month or so.

Dr. Barry Eppley

Indianapolis, Indiana