Which is Better Cheek Implants or a Zygomatic Sandwich Osteotomy?

Q: Dr. Eppley, For the cheek implants, I was wondering if you carve standard implants a bit to tailor it to the anatomy? I was also wondering if you believe a zygomatic sandwich osteotomy (ZSO) is a possible alternative to cheek implants. I heard with a ZSO or by cutting the cheekbones and moving it, it is hard to get a high anterior augmentation.

A: The Zygomatic Sandwich Osteotomy (ZSO) technique creates lateral cheek width and, by that effect, makes the anterior cheek looks less prominent. (more flat) As indicated in the attachment, it is a vertical osteotomy cut done through the main body of the zygoma from inside the mouth. The outer body of the cheek and zygomatic arch is then pushed outward and held there by an interpositional graft and plate fixation

For those patients who need that type pf dimensional cheek change then this autologous cheek augmentation would be effective. But in the patient who needs any anterior cheek cheek projection this is not the correct procedure. It takes an implant to create that effect as the bone movement of the ZSO doesn’t go in that direction.

I like this operation but there is nothing in your goal pictures that would suggest this is the desired type of cheek augmentation change you seek.

Dr. Barry Eppley
Indianapolis, Indiana