Your Questions
Your Questions
Q: Dr. Eppley, I have a problem with my cheek implants and I need either cheek implant removal or cheek implant revision. I had a severe damage from buccal fat pad removals when I was younger and that left me sagging cheeks, downturned mouth corners, and jowls. Then I got medium sized submalar cheek implants to correct this problem. I looked fine and then I got a facelift which lifted the corners of my mouth and got rid of my jowls. But that has now left me with the cheek implants sticking out like shelves and my face looking like a skeleton. I got your information online that you have helped a patient with similar situation and I would like to get your advice.
Q: Between your previous buccal lipectomies and the pull of the facelift (which can thin out the submalar region by its sweeping effect) cheek implants can be come prominent and create an ‘hourglass’ facial deformity. The best approach would not be to completely get rid of the existing cheek implants as that will likely create a very flat cheek look creating another aesthetic problem. I would recommend downsizing your cheek implants (by at least 50%) and placing fat injection grafts below them to eliminate the ‘shelves’ and create a more natural and smoother facial contour. Cheek implant revision would be preferred.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently had cheek implants and facial liposuction done just a week ago. While my face is distorted from the swelling I already know that the cheek implants are not right. They are asymmetric and in the wrong place. After speaking with my surgeon, he stated he would only remove the old 2.5mm implants and would be unwilling to place new implants at the time of removal. What I don’t like is that there is still no projection to my midface in profile, which is my primary reason for undergoing the procedure. I’m curious if a 4mm silastic implant would provide a better result. I wanted to look like Jessica Biel or Megan Fox. Please let me know your opinion. If your professional opinion is to keep the 2.5mm, then I would still like to try a filler for the area directly below my eye to give my midface more projection and also to discuss refining my chin/jaw.
A: I am glad to hear that you have gotten to speak to your original surgeon as he is the one who knows what type of cheek implants were placed (I know its Medpor but don’t know the style)
While your cheek implants can certainly be replaced (cheek implant revision), an important issue would be to known what is the starting point. While the swelling in your face has come down, there is still about 50% swelling to resolve. So my concern is that the shape of your face is not completely ‘known’ nor is the final effects of what the current cheek implants will look like. That makes to hard to know what cheek implant style to change into when you are working with a ‘moving target’ as the swelling goes down and the final shape of the current implants become evident. What you don’t want to do is to change the implants and then find out what you have changed into is no better for a different reason.
It is also unclear as to what you mean by more ‘midface projection’. The term midface is an ambiguous one and means different things to different people so more clarification on this issue is needed. Cheek implants in general do not create midface projection, they create cheek projection.
Dr. Barry Eppley
Indianapolis, Indiana
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, two months ago I got 6 mm silicone malar shell implants put in. I have flat cheekbones and full cheeks so the goal was to achieve higher, chiseled cheekbones (without placing them too laterally because I didn’t want the overall width of my face to look wider). To be clear, I do not have a combined malar/submalar implant because I did not want to augment my submalar region. Is the malar shell the implant you would have used or would the Medpor RZ malar implant work better to achieve prominent, high cheekbones? Thanks so much.
A: Quite frankly I would have used neither. All silicone malar shell implant styles are fairly wide which are going to give a round look to the cheek more than a high angular look. The medpor RZ implant is a lower projecting cheek implant style that will not give a high lateral look either. In reality, there is no really one good cheek implants style that will give that highly placed chiseled look in many patients. The best cheek implant that I have found is to either cut the silicone malar shell implants in half so that only the highest part stays or to use a so-called anatomical (style 1) implant that only imparts fullness to the high malar region.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr.Eppley, will you look at patients that had cheek implants performed by another surgeon? The surgery was performed a month ago and they are asymmetrical and one side is more swollen then the other. They don’t look right. I would like them revised or removed.
A: Thank you for your inquiry. The first thing to realize about cheek implants is that the swelling between the two sides is never exactly symmetrical. Even though you do exactly the same thing to both sides, they will have differential amounts of swelling. Secondly, it really takes almost three months to see the final results from the procedure. It takes this long to have almost all of the swelling gone and to see if true cheek implant asymmetry exists. Since you are only one month from surgery (which does seem like forever when you are the patient), it is too early in my opinion to yet assume that the cheek implant placements have been asymmetrical. That being said, I would be happy to assist you. Please send me some pictures and any information about your surgery (when, type of implants if you know etc) that you know. Let us assume that after three months, this cheek asymmetry persists. Since there is asymmetry, I am assuming that there is one good side and one unhappy asymmetric side. That raises the question about whether the off side should be adjusted to better symmetry, changing the styles and position of the implants on the cheeks (there was a good reason you have it done to begin with) or simply having them removed altogether. At that point, we can delve into what your original objectives were for getting the cheek implants and see if that effort can be salvaged.
Dr. Barry Eppley
Indianapolis, Indiana