Your Questions
Your Questions
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
Indianapolis, Indiana
Q: Dr. Eppley, I am scheduled to have an old cheekbone fracture reapir procedure by you in a few weeks. The two procedures you will perform on me are: (21407) treatment of fracture of orbit except blowout with implant Left side and (21270) augmentation of cheekbone left side. My questions are what exactly will you be doing as far the actual repairs? Will it require breaking the bone? If screws are used anytime in the procedure, will that negate my ability to have an MRI of the head region in the future because of the metal? Will I feel the implants and screws in my face when I rub it? Lastly, how durable will the implants be if I get hit in the face playing basketball? Thank you for being able to help me restore my features after so long of an injury. I trust you and your reputation and I feel I am in the best competent hands possible.Thank you for your time.
A: Your old cheekbone/infraorbital rim fracture is going to be treated by a camouflage technique to build out the depressed bone and lower eyelid and cheek facial areas. This would be a combined cheek implant and infraorbital rim implant. Any implants used would be screwed into place with very small titanium screws. (about the size of eyeglass screws) They do not interfere with any type of x-rays. With such an old and healed facial fracture there is no benefit to breaking the bone and repositioning it. That would be very traumatic and less effective at this point that building out and filling in the obvious facial indentations/asymmetry. These implants are very durable and would pose no problems playing contact sports. In some ways you can think of them like placing protective bumpers on the bone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had my cheekbone broken two years during an assault. At the time, I did not have it fixed by having plates inserted and it has since healed. My cheekbone is flatter on this side and my face is slightly asymmetrical and uneven. Since then, my friends misinterpret my facial expressions thinking I am smirking or grimacing when I am not. I am sensitive about my facial asymmetry and am wondering if it is worth the time and effort to repair. Thank you so much.
A: Cheekbone or zygomatic fractures display a classic pattern of displacement when fractured. The body of the cheekbone rotates down and inward with partial displacement into the maxillary sinus. This reduces the prominence of the cheek bone by this inferior rotation, making the cheek flatter and the face asymmetric. Primary surgical repair repositions the cheekbone back into place and holds it there with plates and screws. But once the fracture is healed, this is no longer a good option in most patients. Rather than moving the bone, it is usually better to treat the facial asymmetry with an implant to restore fullness to the cheekbone. This is a far simpler surgery than major zygomatic osteotomies and repositioning. A one-sided cheek implant is a simple surgery that takes 30 minutes of surgery and improves much of the aesthetic asymmetry of the fractured but healed cheekbone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My cheekbone injury is over 8 years old. I know doctors are leary of healed/mended cheekbones. Should have initially went to hospital but because of lack of insurance and being raised to believe a black eye is just that. I was even getting carded at 30, took only about 8months before that ended. So now I am 38 and skin is creased/hollowed only on that side. I went to a plastic surgeon but they don’t know what I am talking about.
A: Many untreated depressed zygomatic (cheekbone) fractures will eventually show a malar or cheek flattening once all the swelling has subsided and the tissues are retracted. For many only the cheek is flatter but in more severe cases the shape of the eye may have changed and the corner of the eye tilted slightly downward. Yours sound like it has malar involvement only. A small cheek implant can usually make a significant improvement. Placed through the mouth on just one side, this can provide a simple and immediate fix to your cheek flatness/hollowness.
Dr. Barry Eppley
Indianapolis, Indiana
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
Indianapolis Indiana
Q: Nearly 15 years ago I was assaulted and punched repeatedly while unconscious. This resulted in broken bones in my face which were never fixed at the time. I have a sunken cheek and I believe my eye has dropped slightly with it. Can my cheek be repaired being that it was so long ago?
A: It sounds like your original facial fracture was of the zygomatic-orbital complex variety which displaced in its classic manner, downward and into the maxillary sinus. When this ‘cheekbone complex’ falls down like this it creates a depressed or sunken cheek (lack of cheek projection/prominence) as well as moving the floor of the eye down with it. (eyeball moves downward)
Just because it has been allowed to heal and needs secondary correction does not preclude that it can be treated. But the type of treatment changes when the injury is old like yours as opposed to when it was a freshly broken. Depending upon the degree of bone displacement, there are two options. If the cheek displaccement is fairly mild, it can be treated with a cheek implant and possibly an orbital floor implant and repositioning of the corner of the eye tendon. (lateral canthoplasty) If the bone displacement is more severe, however, it is better to cut the cheekbone complex (osteotomy) and do bone grafting. Simply trying to build up bone with implants that is way out of position does not produce a result that looks very natural.
Dr. Barry Eppley
Indianapolis Indiana