Q: Dr. Eppley, I’m sure a surgeon at your level is capable of the best possible cheek augmentation results. However, for cheek implants performed in general, I am a little concerned about having found an average self-reported procedure satisfaction rating of only about 60% from this site called Realself. Could you tell me more about satisfaction-levels and potential complications for these procedures? Could they affect the shape of the nose?
A: It does not surprise me that the satisfaction rating for cheek implants is around 60% or roughly two-thirds of the patients that took the time to register their experience. While it is an apparently ‘simple’ procedure, it can be plaqued by problems of implant asymmetry and an inability to have achieved the desired cheek augmentation effects. It is important to remember that all facial implants, cheek implants included, are based on styles that presumably fit the average person. Often these implant styles, in my opinion, are dated and may not reflect contemporary aesthetic objectives. Thus surgeons are relegated to using cheek implant styles that are not really specific to the patient’s anatomy and may not always have a realistic chance to achieve the patient’s cheek augmentation goals. But plastic surgeons may due with what they are provided and try to get the result with the cheek implants that are available.
It is also important to note that cheek implants are paired unlike a chin implant which is singular. Since they must be placed independently and without full view of either one at the same time, the potential risks of implant asymmetry are increased.
Lastly, there is no training manual or intuitive aesthetic ability for plastic surgeons to knowing how to pick a cheek implant style and size. Cheeks, unlike chins, are more than just a single horizontal measurement seen in just one profile view. (which is how most plastic surgeons simplistically see the chin…unfortunately) Rather the shape of the cheeks is truly a three-dimensional structure (with four different aesthetic zones) where number and measurements do not help in knowing how to make a successful cheek augmentation change.
Dr. Barry Eppley
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
Q: I am interested in cheek implants and until now I have thought that this compared to other plastic surgery procedures would be a relatively simple procedure with a minimum of complication rate. Recently I have seen a scary video on Youtube that shows a patient who developed a bunch of complications a few weeks after this procedure. He isn´t able to smile on one side of his face. One implant moved the whole way down the cheekbone and the other implant developed some kind of air pocket between the cheekbone and implant.One of the implants got infected. This patient also mentioned in his video that the surgeon removed some bone of his cheekbones before he inserted the implants. I can imagine that you don´t like to comment on another surgeon´s work. Could you please tell me if these are complications that could have been easily avoided by a well trained surgeon?
A: You would be correct in assuming that I wouldn’t comment on any specifics about another surgeon’s work or results. That is not a protective maneuver for other surgeons but because many details of other patient’s surgeries and cases are not known to me and often how the information is presented may not be complete. There is also the old motto of ‘there are two sides to every story’.
But I can make some general comments about cheek implants and their potential outcomes and complications. I have never seen the type of complications from cheek augmentation that you have described. In my experience, the most common complications are aesthetic in nature. Asymmetry of cheek implant position or too large a size or incorrect implant style for the desired effect are more likely complications to be seen. These can be resolved by implant adjustment and/or replacement. Infection of the implant is also a potential complication but this is uncommon in my experience with cheek augmentation. I have done many cheek implants in combination with maxillary or LeFort osteotomies, where the implant sits directly over an open sinus cavity, and have yet to see an infectious outcome with its use in that ‘higher risk’ use. The best way to avoid many of these cheek implant problems is to secure them to the underlying bone with a screw and get a good two-layer soft tissue closure over them.
I have a hard time figuring out how any type of permanent facial nerve injury can occur from cheek augmentation as the terminal buccal branches of the facial nerve are well above the subperiosteal dissection used for the placement of the implants across the zygomatic bone surface.
Dr. Barry Eppley