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Cheek augmentation
Cheek augmentation
Cheek augmentation
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Cheek augmentation is a cosmetic surgical procedure that is intended to emphasize the cheeks on a person's face. To augment the cheeks, a plastic surgeon may place a solid implant over the cheekbone. Injections with the patients' own fat or a soft tissue filler, like Restylane, are also popular. Rarely, various cuts to the zygomatic bone (cheekbone) may be performed. Cheek augmentation is commonly combined with other procedures, such as a face lift or chin augmentation.

Implants

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Materials

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Cheek implants can be made of a variety of materials. The most common material is solid silicone. In addition, two popular options are high-density porous polyethylene, marketed as Medpor, and ePTFE (expanded polytetrafluoroethylene), better known as Gore-Tex. Both Medpor and ePTFE are inert substances, providing better integration with the underlying tissue and bone than solid silicone. However, in the case of Medpor, the implants' integration and ingrowth with the underlying tissue causes difficulty removing the implant if revisions are needed.[1][2]

Shapes

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There are three general shapes to cheek implants: malar, submalar, or combined. Malar implants, the most common shape, are placed directly on the cheekbones. The result is more projection to the cheekbones, providing a "higher" contour to the side of the face. In contrast, submalar implants are not placed on the cheekbones. They are intended to augment the midface, especially if the person has a gaunt or "sunken" appearance to this area. Combined implants or malar/submalar combination, are an extended implant intended to augment both the midface and the cheekbones.[3]

Incisions

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A surgeon will usually make an incision in the upper mouth near the top of the gum line and slide the implants into place. Another method is to make an external incision near the eye, but most patients do not choose this method since it can create a visible scar. However, the intraoral (inside the mouth) approach carries a higher risk of infection since the mouth contains more bacteria. Cheek implant surgery is usually performed under sedation or general anesthesia and take about one to two hours. Recovery from this surgery usually takes about ten days.[4]

Risks

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As with any surgery there is a risk of infection, postoperative bleeding, formation of a blood clot, and severe swelling. Asymmetry is a risk with all forms of cheek augmentation. This can occur due to uneven resorption, implant displacement, or shifting. This shift can happen due to swelling, trauma or scarring. Although a temporary loss of sensation is common, an extended loss of sensation can occur with any surgery, especially cosmetic plastic surgery.[3]

Fillers or injections

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Injections to the cheekbones to provide a less invasive and less expensive approach to cheek augmentation. A hyaluronic acid, such as Restylane or Juvederm, can be injected to the cheek area. Autologous fat is considered a "more permanent" option, but all are eventually completely resorbed.[5]

Zygomatic osteotomy

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A zygomatic "sandwich" osteotomy is far less common. The procedure is often indicated during reconstructive surgery for birth defects or traumatic injury. During this procedure, the zygoma, or cheekbone, is separated by bone cuts near the orbital rim and maxilla. The bone is then moved outward and a solid material, such as hydroxylapatite, is wedged in place to hold the new position of the zygoma.[6]

References

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Revisions and contributorsEdit on WikipediaRead on Wikipedia

Cheek augmentation

View on Grokipedia
from Grokipedia
Cheek augmentation is a cosmetic procedure aimed at enhancing the volume, projection, or lift of the cheeks to improve facial contour and achieve a more youthful or balanced appearance, often addressing age-related volume loss, flat cheeks, or . This can be accomplished through surgical or non-surgical methods, with the choice depending on desired permanence, recovery time, and individual anatomy. Surgical options for cheek augmentation primarily include cheek implants and autologous fat grafting. Cheek implants involve the placement of solid, biocompatible materials—such as or porous (e.g., Medpor®)—over the cheekbones via intraoral or subconjunctival incisions, typically under general , to provide permanent volume enhancement. In contrast, fat grafting, also known as fat transfer, harvests fat from another body area (e.g., or thighs) via , processes it, and injects it into the cheeks to restore natural fullness; this technique, refined since its early uses in the late and standardized in the 1990s, offers semi-permanent results as some grafted fat may be reabsorbed. Both surgical approaches are outpatient procedures lasting about one hour, suitable for healthy adults with realistic expectations, though candidates should avoid and manage conditions like . Non-surgical alternatives, such as dermal fillers, provide a less invasive entry point for cheek augmentation and are among the most popular minimally invasive cosmetic treatments. These involve injecting hyaluronic acid-based substances (e.g., Juvéderm®), calcium hydroxylapatite (e.g., Radiesse®), or other biocompatible fillers into the midface to add immediate volume and lift cheekbones, with procedures taking 15 minutes to two hours and yielding results lasting from six months to over two years depending on the product. Fillers are reversible and appeal to those seeking temporary enhancement, though repeated sessions are needed for sustained effects. In 2024, cheek augmentation procedures saw notable demand, with 9,130 surgical malar augmentations (including implants and fat grafting) performed —a 3% increase from the prior year—while soft tissue fillers, often used for cheeks, ranked as the second most common minimally invasive treatment overall. Benefits include improved harmony and self-confidence, but potential risks encompass swelling, bruising, , , or implant displacement, necessitating consultation with board-certified plastic surgeons. Recovery varies: fillers allow quick return to activities with minimal downtime, whereas surgical methods involve one to two weeks of swelling and dietary restrictions.

Overview

Definition and Purpose

Cheek augmentation is a cosmetic procedure designed to enhance the volume, projection, or definition of the cheeks through either surgical or non-surgical techniques, aiming to create a more balanced, youthful, or sculpted facial appearance. This enhancement targets the midfacial region, particularly the malar area, to address deficiencies in contour and structure. The primary purpose of cheek augmentation is to correct flat or sunken cheeks resulting from aging-related volume loss, genetic factors such as skeletal , or trauma, while also enhancing prominent cheekbones for aesthetic appeal and restoring in reconstructive cases. By increasing midfacial projection, the procedure helps achieve greater facial harmony and a rejuvenated look, particularly for individuals with underdeveloped or aging features. Benefits of cheek augmentation include improved overall facial aesthetics, which can enhance self-perception and by aligning features with desired proportions. Non-permanent options, such as injectables, offer reversibility, allowing patients to test enhancements before committing to longer-lasting changes. Prominent cheeks have long been revered in various societies as symbols of , , and , influencing modern aesthetic ideals across cultures, including preferences for high cheekbones in Western, Asian, and Middle Eastern contexts.

History

The aesthetic ideal of prominent cheekbones has been evident in various ancient cultures. Initial surgical advancements in facial reconstruction emerged around 600 BC, when the Indian physician described techniques using cheek skin flaps for in his text, the , marking an early milestone in . In the late , the pursuit of augmentation led to the introduction of injectable fillers, with becoming the first such agent used for enhancement starting in the 1890s. However, its application was largely abandoned by the early due to severe complications, including migration, , and formation. Concurrently, autologous transfer was pioneered in 1893 by German surgeon Gustav Neuber, who successfully transplanted small fat parcels from the arm to fill scars, laying the groundwork for modern fat grafting despite initial challenges with graft survival. The mid-20th century saw the formal introduction of cheek implants in 1956, utilizing materials like to provide permanent structural enhancement to the midface. In 1981, the U.S. (FDA) approved bovine as the first injectable agent for cosmetic use, enabling temporary volume restoration in facial procedures including cheek augmentation, though it required prior skin testing due to allergy risks. The modern era of cheek augmentation, beginning in the late and accelerating in the 2000s, featured the rise of -based fillers, with receiving FDA approval in 2003 for augmentation, offering reversible and natural-looking results that shifted preferences toward minimally invasive techniques. Advancements in implant materials post- included refined designs for easier removal and porous (e.g., Medpor) for improved tissue integration and reduced migration risk, further enhancing surgical options while non-surgical injectables dominated due to lower downtime. In the 2020s, innovations such as 3D-printed customized implants and advanced formulations have continued to refine outcomes for personalized augmentation.

Non-Surgical Methods

Dermal Fillers

Dermal fillers offer a non-surgical approach to cheek augmentation by injecting biocompatible substances into the mid-face to restore volume, enhance contours, and create a more youthful appearance. These injectables are particularly suited for addressing age-related volume loss in the cheeks, providing subtle lifting effects without incisions. Common types of dermal fillers used for cheek augmentation include (HA)-based products such as Juvederm and , which are temporary and gel-like in consistency; calcium hydroxylapatite (CaHA) fillers like Radiesse, which are semi-permanent and stimulate production; and poly-L-lactic acid (PLLA) fillers such as , which promote gradual volume restoration through neocollagenesis. HA fillers are fully temporary, lasting 6-12 months, while CaHA offers results up to 12 months and PLLA up to 24 months, depending on the patient's and injection volume. The procedure is typically performed in an outpatient setting and involves injecting the filler into the deep dermal or submuscular layers of the mid-face, often using fine needles for precise placement or blunt-tipped cannulas to minimize bruising and vascular risks. It lasts 15-30 minutes, with topical numbing cream or applied beforehand to ensure comfort; the provider may use techniques like linear threading or fanning to distribute the filler evenly along the and malar regions. Results from dermal fillers appear immediately, with full effects visible after any initial swelling subsides within a few days to a week. HA fillers provide instant plumping, while PLLA may require multiple sessions spaced 4-6 weeks apart for optimal volume buildup. Key advantages of dermal fillers for cheek augmentation include their minimally invasive nature, allowing patients to resume normal activities immediately with little to no downtime, and the reversibility of HA-based options using enzyme injections if adjustments are needed. This contrasts with more permanent surgical implants, which involve greater invasiveness but longer-lasting outcomes.

Surgical Methods

Cheek Implants

Cheek implants involve the surgical insertion of solid prostheses to enhance cheek projection and contour, providing a permanent solution for augmentation. These implants are positioned over the to create balanced proportions and a more defined midface structure. Unlike temporary non-surgical options such as dermal fillers, cheek implants offer lasting results but require a surgical commitment. Implants are available in various types and shapes to address specific aesthetic needs. Malar implants focus on augmenting the prominence of the cheekbones for a higher, more angular appearance, while submalar implants target the area beneath the cheekbones to fill out a sunken midface. Combined malar-submalar implants provide both projection and volume for comprehensive contouring. Standard sizes are commonly used for predictable outcomes, but custom implants can be fabricated based on individual facial anatomy using imaging technology for precise fit. Common materials for cheek implants include medical-grade , which is solid and flexible for easy placement and adjustment; porous , such as Medpor, which allows tissue ingrowth for enhanced stability. implants are favored for their and removability if needed, while porous supports long-term fixation through biological incorporation. The procedure is typically performed under general and lasts 1-2 hours as an . Access is gained through intraoral incisions inside the or external incisions under the lower to minimize visible scarring. The implant is then placed over the zygoma and secured using nonresorbable sutures or screws to ensure stability. Incisions are closed with absorbable sutures, allowing for immediate post-operative care. Recovery involves initial swelling that peaks around 2-3 days post-surgery, with most bruising and discomfort subsiding within 1-2 weeks. Patients can often resume light activities after a few days, though full results emerge in 1-3 months as swelling resolves and tissues adapt to .

Zygomatic Osteotomy

Zygomatic is an advanced surgical technique used to enhance cheek projection by cutting and repositioning the , providing structural augmentation for the midface in cases where methods are insufficient. This procedure addresses underlying skeletal deficiencies, resulting in permanent changes to contour through and healing. It is typically reserved for scenarios demanding significant volumetric increase or correction of bony asymmetries, distinguishing it from less invasive options like implants, which may suffice for milder deficiencies. Indications for zygomatic osteotomy primarily include severe midfacial , where the cheekbones are underdeveloped, leading to a flat or concave appearance, or significant requiring structural realignment. It is often employed in reconstructive contexts, such as correcting congenital deformities like Treacher-Collins syndrome or cleft lip/palate sequelae, or as part of for class II or III malocclusions with maxillary deficiency. Patients with high aesthetic demands but underlying skeletal issues, such as long-face patterns or mandibular /, benefit from this approach to achieve balanced facial harmony. The procedure is performed under general anesthesia, often via an intraoral upper sulcus incision to access the , minimizing external scarring. Key steps involve subperiosteal followed by precise cuts: a vertical using a piezoelectric or along the zygomatic body and a horizontal oblique cut to allow mobilization. The zygomatic segment is then advanced anteriorly and laterally by 3-10 mm, depending on the degree of , creating a for controlled repositioning. Fixation is achieved with miniplates (typically 2.0 mm) and screws to secure the in its new position, with optional bone grafts from cranial sources if gaps exceed 4 mm. The surgery duration ranges from 2-4 hours for isolated cases, though combined procedures extend this time. Variations include isolated zygomatic advancement for purely cosmetic or focal corrections, accessed intraorally, versus combined approaches integrated with Le Fort I maxillary or mandibular procedures for comprehensive orthognathic correction. In the latter, the zygomatic enhances malar prominence synergistically with maxillary advancement, avoiding the need for grafts in smaller movements. This modification of earlier techniques, such as Tessier's zygoma plasty, emphasizes preservation of the and orbital rims to maintain structural integrity. Postoperatively, patients may require intermaxillary fixation or wiring of the jaws for 2-6 weeks if combined with orthognathic elements, to stabilize occlusion during initial healing. Swelling and bruising peak within 3-5 days, resolving over 2-4 weeks, with a soft diet recommended initially. occurs progressively, achieving solid union in 6-12 weeks, yielding permanent results as the repositioned zygoma integrates and remodels. Follow-up , such as CT scans at 1 month, confirms positioning, with full aesthetic outcomes evident by 6-12 months.

Risks and Complications

General Risks

Cheek augmentation procedures, encompassing both non-surgical and surgical techniques, involve risks related to that apply across methods. Non-surgical approaches, such as dermal fillers, typically use topical numbing agents or anesthetics like lidocaine, which can lead to allergic , itching, , or rare systemic manifesting as neurological symptoms or cardiac arrhythmias if overdosed. Surgical methods may employ , regional, or , with carrying risks of (exacerbated by opioids), respiratory depression, or airway complications, particularly in facial procedures where positioning affects ventilation. Allergic to anesthetic agents occur infrequently but can include , while respiratory issues are more pronounced in elderly patients or those with comorbidities. Common invasive risks shared by all cheek augmentation methods include bleeding, hematoma formation (accumulation of blood under the skin), seroma (fluid buildup), , poor , and scarring. These complications arise from tissue disruption during injection or incision, with rates generally low (around 1-2% in facial procedures) but potentially requiring antibiotics or drainage. Bleeding and are more immediate concerns in surgical cases but can also occur with needle-based filler injections, while poor healing and scarring are influenced by individual factors like or . Fluid collections like seromas may resolve spontaneously but occasionally necessitate aspiration. Facial-specific risks involve temporary bruising, swelling, and numbness due to disruption of superficial tissues and , often resolving within weeks but contributing to if healing is uneven. Swelling and bruising are nearly universal post-procedure effects, peaking in the first 48 hours and managed with and elevation, while numbness from irritation affects sensation in the cheeks and may persist temporarily. can result from uneven volume distribution or bilateral procedure variations, though it is usually correctable. These effects highlight the importance of postoperative care to minimize distortion. Long-term risks include persistent changes in facial sensation, such as chronic numbness or from nerve damage, and the potential need for revision procedures to address suboptimal outcomes. Sensation alterations occur in a minority of cases but can impact if unresolved. Revision rates vary by method but are reported at approximately 3-5% for surgical implants due to issues like displacement, with overall complication rates across techniques ranging from 2-6%, sometimes necessitating corrective surgery.

Method-Specific Complications

In non-surgical cheek augmentation using dermal fillers, allergic reactions can occur, manifesting as swelling, redness, or more severe responses mediated by T lymphocytes. Vascular occlusion is a rare but serious complication, potentially leading to tissue or blindness if the filler inadvertently enters arteries during injection in the cheek area. These risks are heightened in the midface due to the vascular , though incidence remains low with proper technique. For autologous fat transfer in cheek augmentation, uneven absorption of the grafted fat can result in contour irregularities, asymmetries, or volume loss over time, often necessitating touch-up procedures. may develop, presenting as palpable lumps or induration, while formation can occur as a delayed in approximately 2% of cases. Surgical cheek augmentation with implants carries risks of displacement or shifting, reported in 3-5% of cases due to inadequate fixation or forces, potentially altering . Extrusion occurs in 2-5% of patients, often linked to or poor implant integration, while can cause firmness or distortion. Interference with facial animation, such as restricted smiling, may arise from implant pressure on underlying muscles. Zygomatic osteotomy for cheek augmentation involves bone non-union or in approximately 5% of procedures, leading to inadequate projection or asymmetry, particularly if fixation is suboptimal. damage is a notable risk, causing persistent or in the midface. Hardware exposure and prolonged are additional concerns, with the latter extending recovery beyond typical timelines. Overall revision rates for cheek augmentation procedures range from 10-20%, with higher rates up to 25% observed in due to its technical complexity and potential for bony healing issues.

References

  1. https://www.plasticsurgery.org/cosmetic-procedures/cheek-augmentation
  2. https://my.clevelandclinic.org/health/procedures/cheek-implants
  3. https://www.plasticsurgery.org/news/blog/fat-grafting-history-and-applications
  4. https://my.clevelandclinic.org/health/treatments/24260-cheek-filler
  5. https://www.plasticsurgery.org/documents/news/statistics/2024/cosmetic-procedure-trends-2024.pdf
  6. https://www.ncbi.nlm.nih.gov/books/NBK603755/
  7. https://pmc.ncbi.nlm.nih.gov/articles/PMC9442877/
  8. https://pmc.ncbi.nlm.nih.gov/articles/PMC6554175/
  9. https://pmc.ncbi.nlm.nih.gov/articles/PMC11000756/
  10. https://ottawarhinoplasty.ca/face-value-amazing-strange-and-intriguing-facts-from-the-history-of-facial-surgery-and-cosmetic-medicine/
  11. https://pubmed.ncbi.nlm.nih.gov/19415573/
  12. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0029-1220645
  13. https://pmc.ncbi.nlm.nih.gov/articles/PMC5006291/
  14. https://www.lakenormanofs.com/what-do-cheek-implants-do/
  15. https://www.fda.gov/media/147036/download
  16. https://www.newbeauty.com/history-of-facial-fillers/
  17. https://pmc.ncbi.nlm.nih.gov/articles/PMC2544360/
  18. https://plasticsurgerykey.com/facial-implants/
  19. https://www.intechopen.com/chapters/1198294
  20. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/221213
  21. https://www.plasticsurgery.org/news/articles/whats-on-the-horizon-plastic-surgery-trends-for-2025
  22. https://www.mayoclinic.org/tests-procedures/facial-fillers/about/pac-20394072
  23. https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers
  24. https://www.plasticsurgery.org/cosmetic-procedures/cheek-augmentation/procedure
  25. https://exploreplasticsurgery.com/zygomatic-osteotomies-cosmetic-and-reconstructive-facial-indications/
  26. https://pmc.ncbi.nlm.nih.gov/articles/PMC12041431/
  27. https://pubmed.ncbi.nlm.nih.gov/8110907/
  28. https://pmc.ncbi.nlm.nih.gov/articles/PMC3901926/
  29. https://www.plasticsurgery.org/cosmetic-procedures/cheek-augmentation/safety
  30. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/509726
  31. https://pmc.ncbi.nlm.nih.gov/articles/PMC5889440/
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