Q: Dr. Eppley, I have a fractured cheekbone. In terms of cheek reconstruction will a fat injection be more beneficial than a cosmetic implant? Please email me your answer.
A: Assuming that you are not going to have the cheekbone fracture repaired acutely or that this is an old healed fracture, you are seeking cosmetic camouflage of the external deformity caused by displacement of the underlying bone. (cheek reconstruction) Both fat injections and an onlay bone implant are viable treatment options. But which one would be better depends on the location and extent of the external facial deformity. Each approach has its advantages and disadvantages. Fat injections are simpler to do with a very quick recovery but their survival is far from assured and, in most cases, requires more than single treatment session. A facial implant offers an assured augmentation result but is more invasive with a longer recovery. (swelling period) In some cases of secondary zygomatico-orbital reconstruction I have combined implants with fat grafting to get the best result.
It would be very helpful to see pictures of your face to determine the nature of your cheekbone fracture deformity. From that I could give you a better idea as to which approach may be best.
Dr. Barry Eppley
Q: Dr. Eppley I need your help with my cheek. Several years ago I was involved in a fight and got struck on the left side of my face. At the hospital they diagnosed me with a cheekbone fracture but I never got it fixed since I didn’t have insurance at the time. The left side of my face is asymmetric now to the other side and I want to get it fixed. I will describe the problem as I see it. If you look at about an inch down from my left eye, that area from the middle of the top portion of the cheek toward the edge of my nose is flattened. It has no definition like my other cheek. The flatness extends down toward the middle portion of my ceek also. It appears to me as the complete area is shaped like a sideways triangle toward the rear. Also in the same area about an inch under my left eye, right on top of the upper portion of my cheek, it appears as if that area has dropped down. Do you think the bone needs to be rebroken to be fixed or can some type of implant be used to fix it? Thanks for your time.
A: Your description of the left cheek/midface deformity is exactly what one would anticipate from an incomplete zygomatic or cheekbone fracture. As the zygomatic complex, when fractured, can only rotate downward and inward toward and into the maxillary sinus you will lose some cheek and underlying anterior maxillary projection. Because you have described no changes in the eye area or numbness of the cheek and teeth (infraorbital nerve impingement) your original zygomatic fracture is incomplete and less severe than a fully displaced fracture. Given the age of the injury and the now healed bone, a modified cheek implant placed across the anterior maxillary wall and up onto the anterior zygoma should do nicely to restore the bone fullness lost. Given the modified position of such a cheek implant, it would need to be secured by multiple screw fixation.
Dr. Barry Eppley