Cheek Implants: Achieve Fuller, More Defined Cheeks

Cheek implants, also known as malar implants, are solid artificial pieces surgically placed over the cheekbones to enhance facial contour and restore lost midface volume. This procedure provides a long-term solution for individuals with flat or under-defined cheeks due to congenital features, aging, or trauma.
Cheek implants are anatomic. They are available in various shapes and sizes, including malar (placed on the cheekbones), submalar (placed under the cheekbones), and combined implants. They are typically made of biocompatible and inert materials such as solid silicone, high-density porous polyethylene (Medpor), and expanded polytetrafluoroethylene (ePTFE), all of which are inert and safe for long-term use.¹Niamtu J. Cheek Implants. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. 2015:371-5.²Hsieh T-y, Dhir K, Binder WJ, Hilger PA. Alloplastic facial implants. Facial Plastic Surgery. 2021;37(06):741-50

Types of Cheek Implants based on Shapes

There are three basic shapes of cheek implants: sub-malar, malar, and combined.

Sub-Malar Implants

These implants fill the anterior sub-malar void. They offer a fuller appearance of cheeks by filling out a sunken or gaunt appearance of the cheeks. They are best for people who experience volume loss due to aging. People with a natural hollow midface can also choose as it softens the nasolabial fold while elevating the midface. These implants are best for women as they give a more contoured and delicate look.

Malar Implants

Malar shells augment the malar region. The malar fat pads are triangular structures.³Niamtu J. Essentials of cheek and midface implants. Journal of Oral and Maxillofacial Surgery. 2010;68(6):1420-9. They are broader and enhance the projection of the cheekbones. They are the best option for people with an underdeveloped or flat midface. Mostly, men prefer to have these implants as they offer a more masculine appearance.

Combined

Combined implants are versatile as they augment both lateral and anterior cheek regions. They provide a fuller look to both the cheekbones and the midface. Combined implants are best for those who want an overall fuller facial appearance.

Types of Cheek Implants Based on Materials

Various types of materials make up the cheek implants. While choosing the implant material is often the first consideration. The different types of cheek implants include:

Solid Silicone

Silicone cheek implants are soft, flexible, and smooth, offering a natural feel. They don’t integrate with surrounding tissues, making them easy to remove or adjust if needed. Available in various shapes and sizes, these implants typically don’t require screw fixation, sitting securely in a pocket created by the surgeon. However, their separation from natural tissues can increase the risk of shifting over time. Additionally, the body may form a capsule of scar tissue around the implant, which can affect its position. Despite these potential risks, many patients prefer silicone implants due to their natural appearance and ease of adjustment. These implants are considered advantageous by some experts, offering a reliable option for cheek augmentation.

ePTFE (Gore-Tex)

Expanded Polytetrafluoroethylene (ePTFE), commonly known by its trademark Gore-Tex, is a flexible and porous material used in facial implants and soft-tissue augmentation.⁴Petroff MA, Goode RL, Levet Y. Gore‐Tex® implants: Applications in facial paralysis rehabilitation and soft‐tissue augmentation. The Laryngoscope. 1992;102(10):1185-9. Depending on the surgeon’s technique, these implants may or may not require screw fixation. Its porosity allows for partial tissue integration, providing stability while still being easier to remove compared to implants with significant tissue ingrowth, like Medpor. Its quality makes it feel more natural. However, due to its limited availability, its use is not as common as other implants. Moreover, it integrates slightly with the tissue, so it is not firm. The low firmness of Gore-Tex can lead to a risk of displacement.

Medpor (Polyethylene)

The Medpor is porous and allows tissue and bone integration.⁵Ng S, Madill S, Inkster C, Maloof A, Leatherbarrow B. Medpor porous polyethylene implants in orbital blowout fracture repair. Eye. 2001;15(5):578-82. This quality helps keep it in place for longer. Over time, the implant becomes a part of you. These implants require screw fixation to ensure their stay and stability. However, as these implants integrate with the surrounding tissues, their removal can be complex. Its surgery is more invasive than other implants.

Procedure for Cheek Implant Surgery

The cheek implant procedure involves the following steps:

• Anesthesia Administration
  The surgeon administers local anesthesia either intraorally (inside the mouth) or transcutaneously (through the skin) to ensure patient comfort.
• Incision Placement
  The incision location depends on the surgical technique used. Commonly, a 1 cm incision is made over the canine tooth and 5 mm above the attached gingiva inside the mouth. Alternatively, an incision may be made beneath the eyelid.
• Subperiosteal Dissection
  The incision is extended through the periosteum (a membrane covering the bone) to access the underlying bone. Subperiosteal dissection is performed over the anterior maxilla with careful attention to protect the infraorbital nerve. For malar (cheekbone) implants, dissection extends toward the malar region and tapers over the medial portion of the zygomatic arch.
• Pocket Creation
  The pocket for the implant is created slightly larger than the implant itself to prevent buckling. However, the pocket must not be excessively large, as this may lead to implant mobility.
• Irrigation and Implant Placement
  The pocket is irrigated with an antibiotic solution to minimize infection risk. The implant is then inserted through the incision using a long tonsil clamp and positioned carefully.
• Positioning the Implant
  The surgeon pulls down the upper lip and gently presses the cheek to ensure the implant is passively positioned without folding or displacement. If the implant becomes displaced, the pocket may need to be adjusted to achieve proper alignment.
• Hemostasis and Closure
  Before closing the pocket, achieving hemostasis (control of bleeding) is crucial. The incision is then sutured with a 4-0 gut suture.
• Post-Procedure Care
  Dressings are typically unnecessary for this procedure. Patients may experience mild swelling or discomfort, which resolves with proper postoperative care.⁶Niamtu J. Cheek Implants. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. 2015:371-5.

Post Op Instructions

After cheek implant surgery, patients are advised to follow specific postoperative care guidelines to ensure optimal healing and minimize complications:

• After the surgery, patients should avoid significant facial movements, such as excessive talking, smiling, or puckering, for several days to allow the implants to settle.
• Surgeons should inform patients that swelling from midface augmentation can be substantial. Explaining this in advance helps set realistic expectations and reduces anxiety.
• Patients may experience compromised lip movement (e.g., puckering or smiling) due to temporary disruption of the lip elevators. This is normal and typically resolves within two weeks as the tissues heal.⁷Niamtu J. Cheek Implants. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. 2015:371-5.

The surgeons will give you some specific instructions that include:

• Instructions about which medications to apply to the incision and which to take orally to aid healing.
• How to care for the surgical site after the surgery.
• Scheduling follow-ups to monitor recovery and address any concerns.
• Instructions on when to contact the surgeon, such as in case of unusual swelling, redness, or pain.

Recovery

Recovery from a cheek implant is usually easy, but it depends largely on the method used for the augmentation. There can be pain after the procedure. Pain management can be through oral medications. The recovery from the incision on the inside of the lip can take a few days to heal completely. The cheeks can also be sore for a few days. The swelling will last for a few weeks. Most patients can return to work within a week, as the swelling becomes less noticeable by this time.⁸Paul Mittermiller M. Cheek Augmentation – Los Angeles [Available from: https://paulmittermillermd.com/procedures/cheek-augmentation-los-angeles.

Complications after Cheek Implant

The scenarios of complications with different types of implants are different.
Implants made up of porous polyethylene integrate with the surrounding tissues. So, their removal is difficult. They can fragment and disrupt all tissues that have ingrown into the implant. With the use of modern silicone cheek implants, complications are rare. It is because of the biocompatibility and tolerance of the material in the body. These implants become encapsulated in a thick fibrous capsule soon after their implantation. Depending on the patient’s desire, the capsule helps stabilize and remove easily.⁹Niamtu J. Cheek Implants. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. 2015:371-5.
The most common complications include:

• Pain
• Swelling
• Bleeding
• Migration
• Extrusion
• Drainage
• Infection
• Permanent injury¹⁰Rayess HM, Svider P, Hanba C, Patel VS, Carron M, Zuliani G. Adverse events in facial implant surgery and associated malpractice litigation. JAMA Facial Plastic Surgery. 2018;20(3):244-8.

Cheek Implants versus Fillers

Here is a comprehensive comparison of cheek implants and fillers.

Final Review

Cheek implants are a popular surgical procedure. This procedure can enhance facial aesthetics. It offers a more youthful and balanced appearance. The manufacturers made these implants with biocompatible materials that integrate well with the surrounding tissues. The implants are a permanent solution for people who want a more defined and contoured face. However, patients should carefully consider the best-suited option for them. First, you must consult with a qualified plastic surgeon. You must discuss the risks and complications associated with your desired aesthetic procedure. People also consider fillers. Cheek implants have initial high costs but can be more economical in the long run as they do not need repeated sessions. Proper planning and realistic expectations are necessary to achieve satisfactory results from cheek implants.

Refrences

• 1
  Niamtu J. Cheek Implants. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. 2015:371-5.
• 2
  Hsieh T-y, Dhir K, Binder WJ, Hilger PA. Alloplastic facial implants. Facial Plastic Surgery. 2021;37(06):741-50
• 3
  Niamtu J. Essentials of cheek and midface implants. Journal of Oral and Maxillofacial Surgery. 2010;68(6):1420-9.
• 4
  Petroff MA, Goode RL, Levet Y. Gore‐Tex® implants: Applications in facial paralysis rehabilitation and soft‐tissue augmentation. The Laryngoscope. 1992;102(10):1185-9.
• 5
  Ng S, Madill S, Inkster C, Maloof A, Leatherbarrow B. Medpor porous polyethylene implants in orbital blowout fracture repair. Eye. 2001;15(5):578-82.
• 6
  Niamtu J. Cheek Implants. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. 2015:371-5.
• 7
  Niamtu J. Cheek Implants. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. 2015:371-5.
• 8
  Paul Mittermiller M. Cheek Augmentation – Los Angeles [Available from: https://paulmittermillermd.com/procedures/cheek-augmentation-los-angeles.
• 9
  Niamtu J. Cheek Implants. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. 2015:371-5.
• 10
  Rayess HM, Svider P, Hanba C, Patel VS, Carron M, Zuliani G. Adverse events in facial implant surgery and associated malpractice litigation. JAMA Facial Plastic Surgery. 2018;20(3):244-8.