Cheek implants, technically known as malar augmentation, are a form of cosmetic surgery designed to enhance the projection and contour of the midface. This involves placing solid, biocompatible materials directly over the cheekbones to create a more defined facial structure. The primary purpose is to address flatness or a lack of definition in the cheeks, often due to natural bone structure or age-related volume loss. Restoring volume to the malar and submalar areas, cheek implants aim to improve facial symmetry and provide a balanced, youthful appearance.
Pre-Surgical Assessment and Implant Selection
The process begins with a thorough consultation and anatomical analysis to ensure the final outcome meets the patient’s aesthetic goals. The surgeon performs a detailed physical examination, assessing the existing bone structure of the zygoma and maxilla, along with the thickness and quality of the overlying soft tissue. This assessment helps determine the ideal size, shape, and placement necessary for achieving optimal facial harmony.
Modern planning often incorporates advanced imaging, such as computed tomography (CT) scans, to create a precise, three-dimensional representation of the facial skeleton. This imaging can be used to select a standard implant from pre-manufactured options, which typically come in various styles like malar, submalar, or combined forms. Implant materials are typically medical-grade solid silicone, which is flexible, or porous polyethylene, which allows for tissue integration over time. The combination of anatomical data and patient goals dictates the specific implant choice before the operation.
Incision Locations for Access
Accessing the malar bone for implant placement is achieved through one of two primary incision techniques, chosen based on the implant type, surgical plan, and surgeon’s preference. The most common approach is the intraoral incision, made inside the mouth, usually high in the buccal sulcus near the upper gum line. This approach offers the advantage of completely hiding the resulting scar within the mouth. The intraoral route provides a direct, upward path to the malar bone, which is suitable for many standard implant shapes.
The secondary method involves a lower eyelid incision, which can be either transconjunctival (inside the lower eyelid) or subciliary (just below the lower lash line). This technique is often preferred when placing implants that extend higher up onto the infraorbital rim, such as custom or infraorbital-malar (IOM) implants. While the subciliary approach leaves a very fine external scar, it offers the surgeon superior visualization and direct access to the superior aspects of the cheekbone, minimizing the risk of implant malposition.
The Surgical Steps of Implant Placement
Once the access incision is made, the surgeon begins the deep dissection to prepare the precise location for the implant. This involves creating a subperiosteal pocket by lifting the periosteum—the tough membrane covering the bone—off the malar bone surface. The pocket must be meticulously sized, just large enough to accommodate the implant without allowing it to shift later. Dissection is performed carefully to avoid damage to the infraorbital nerve, which provides sensation to the cheek and upper lip.
The implant is then carefully inserted into the newly created subperiosteal pocket through the initial incision, often using specialized instruments to guide it into the correct position. Proper positioning is confirmed by tactile feedback, ensuring the implant sits flush against the bone and follows the intended contour.
After positioning, the next step involves fixation to prevent the implant from migrating or shifting post-surgery. While some surgeons rely solely on the tight subperiosteal pocket to hold the implant, many opt for mechanical fixation. The most secure methods involve anchoring the implant directly to the underlying bone, often using one or two small, self-drilling titanium screws. Alternatively, the implant can be secured by placing non-absorbable sutures through small holes drilled into the implant and then anchored to the periosteum.
The final stage is closure of the incision site. If an intraoral incision was used, it is typically closed with absorbable sutures that dissolve naturally over several weeks. A lower eyelid incision is closed using fine sutures to minimize scarring, with external stitches usually removed within five to seven days. Before the final closure, the surgical site is carefully irrigated to remove any debris and check for hemostasis.
Immediate Post-Operative Care and Recovery Timeline
Following the procedure, patients are monitored briefly before being discharged, as cheek implant surgery is generally performed on an outpatient basis. Immediate post-operative management focuses on controlling expected swelling and bruising, which typically peak within the first 48 to 72 hours. Patients are instructed to keep their head elevated for at least the first week to help minimize fluid accumulation.
Pain is usually managed with prescription medication for the first few days, transitioning to over-the-counter pain relievers as discomfort subsides. If an intraoral incision was utilized, meticulous oral hygiene is required, often involving specialized mouth rinses to keep the incision site clean. A soft or liquid diet is recommended for five to ten days to avoid excessive chewing or pressure on the healing implants. Most patients can return to non-strenuous work and light daily activities within one week. Strenuous exercise, heavy lifting, and activities risking impact to the face are restricted for approximately four to six weeks to ensure the implants fully stabilize in their new position.