Professional Cosmetic Surgery and Healthy Ageing Clinic
The cheeks play an important role in defining an attractive face, and well-defined cheek bones have long been recognised as a hallmark of beauty. Sufficient volume of the cheek contour is essential to a youthful appearance. As people age, the fat pads and soft tissue that give cheeks their fullness, begin to descend and bone thinning begins, creating a flat visage. In addition the supportive tissue beneath the skin begins to erode, hastening the appearance of lines and wrinkles.
A weak cheek structure can make the face appear drawn and gaunt. It may also give the appearance of a 'fleshy' lower face.
Aesthetic procedures offer various ways to restore a more youthful appearance to the cheeks, like cheek and mid face lift and cheek augmentation by mean of injectables or implants.
When considering cheek augmentation it is essential to consider the overall structure of the face (not look at the cheeks alone as a standalone entity) and how the cheeks can be enhanced to blend in and balance with the neighbouring structures as well as identifying any naturally occurring asymmetries.
Cheek augmentation is a procedure to enhance the cheek volume and improve contour by means of injectables that provide temporary results or cheek implants that offer a more permanent solution.
Cheek implants fill out the mid face with precision and permanence and is most suitable for those who are looking for long term results.
Indications for surgery
- Sunken, hollow cheeks
- Weak cheek structure that makes the face appear drawn and gaunt
- The appearance of a ‘fleshy’ lower face due to saggy cheeks
Contra-indications for surgery
- Unusually round face
- Exceptional lack of soft tissue cover
- Any infection in the body, especially around the mouth (in the tooth or sinus infections)
- High expectation patients and perfectionists
- Patients with high risk factors
Some people need bone advancement surgery for maximal results. In such cases a consultation with a maxilo- facial surgeon is advisable.
In some cases facial x-rays and scan may be recommended.
Cheek implants – Types and positioning
Cheek implants are usually made of material such as medical - grade silicone, Medpore or gortex . They come in a wide variety of shapes and sizes which can be further custom trimmed by the surgeon to suit individual patient’s needs, for a more natural look.
Cheek implants can be placed over (malar) or below (sub-malar) the cheek bones. A malar implant will cause a heightened curve of the cheek bone, while a sub-malar implant is generally used to correct a sunken or hollow looking mid-face.
Anatomical shaped implants will wrap around the whole area.
Selecting an implant
The implant should be chosen in accordance with the patient’s facial configuration and their interests in mind. Mostly medium to small size implants are chosen. Rarely large sized implants are a choice. Anatomical shaped implants are more advisable as compared to the others.
Medpore implants encourage soft tissue in growth, are more stable and do not require sutures to hold them in place. They are however difficult to remove.
Anaesthetic and hospital stay
Generally a combination of local anaesthetic and sedation is used. Occasionally a combination of local and general anaesthetic is recommended. One night stay at the hospital is recommended though it can also be performed as a day case.
The incision for cheek implantation is usually made inside the mouth between the cheek and the gum without any visible scar outside.
If the procedure is done in conjunction with a facelift or an eyelid surgery, the same incisions will be used for the insertion of the cheek mplants.
The Surgery usually takes 45 to 90 minutes. To insert the implant the surgeon elevates the soft tissue to form a pocket in front of the cheek bone, and places the implant into the cavity, creating the desired contour. Adequate pocket is made in the right direction so that the implant fits in snugly without movement. In most cases a properly located and sized implant is sufficient to hold the implants in place. Sometimes absorbable fine sutures may be needed to hold them in place. Silicone implants require stitching to avoid displacement.
A soft food diet may be required for a few days as chewing may be limited. There will be initial swelling and bruising that can last for several days. Regular adequate mouth wash is essential for 4 weeks. Pain killers and anti-biotic are prescribed following the surgery. Facial cheek support is recommended for up to 4 weeks to reduce the swelling.
Chewing food and brushing your teeth might be a little uncomfortable for a week to ten days. Bruising will settle in about 10 days although swelling can last for 6 weeks even longer in some cases. A tenderness and tight stretched feeling can be expected for few weeks.
It is important that the patient should be mentally prepared for the new look to ensure acceptance of the augmented face.
Although rigorous activity should be avoided for the first few weeks , you can resume gentle activities in a week to 10 days. Full rigorous activity can be resumed in 4 weeks. The final result is usually visible at the end of 3 months.
10 days (suture removal), 6 weeks, 3 months, 6 months, 1 year
Usual combination procedures
- Face lift
- Brow lift
- Chin implant
- Nasal implant
Longevity of results
The results usually last from 10 years to a life time depending on the durability of the implant, life style changes and effects of aging.
Limitation of results
- Visibility and palpability of implant edges
- Magnification of pre-existing asymmetry
- Less results compared to bone advancement
- Frequent infection, capsulation and displacement may force removal of implant