Cheek augmentation is a cosmetic surgical procedure that is intended to emphasize the

cheek The cheeks ( la, buccae) constitute the area of the face below the eyes and between the nose and the left or right ear. "Buccal" means relating to the cheek. In humans, the region is innervated by the buccal nerve. The area between the insi ...

s on a person's face. To augment the cheeks, a plastic surgeon may place a solid implant over the

cheekbone In the human skull, the zygomatic bone (from grc, ζῠγόν, zugón, yoke), also called cheekbone or malar bone, is a paired irregular bone which articulates with the maxilla, the temporal bone, the sphenoid bone and the frontal bone. It is si ...

. Injections with the patients' own fat or a soft tissue filler, like

Restylane Restylane is the trade name for a range of injectable fillers with a specific formulation of non-animal sourced hyaluronic acid (HA). In the United States, Restylane was the first hyaluronic acid filler to be approved by the U.S. Food and Drug A ...

, are also popular. Rarely, various cuts to the

zygomatic bone In the human skull, the zygomatic bone (from grc, ζῠγόν, zugón, yoke), also called cheekbone or malar bone, is a paired irregular bone which articulates with the maxilla, the temporal bone, the sphenoid bone and the frontal bone. It is s ...

(cheekbone) may be performed. Cheek augmentation is commonly combined with other procedures, such as a

face lift A facelift, technically known as a rhytidectomy (from the Ancient Greek () "wrinkle", and () "excision", the surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful facial appearance. There are mul ...

or chin augmentation.

Implants

Materials

Cheek implants can be made of a variety of materials. The most common material is solid

silicone A silicone or polysiloxane is a polymer made up of siloxane (−R2Si−O−SiR2−, where R = organic group). They are typically colorless oils or rubber-like substances. Silicones are used in sealants, adhesives, lubricants, medicine, cookin ...

. In addition, two popular options are high-density porous

polyethylene Polyethylene or polythene (abbreviated PE; IUPAC name polyethene or poly(methylene)) is the most commonly produced plastic. It is a polymer, primarily used for packaging ( plastic bags, plastic films, geomembranes and containers including b ...

, marketed as '' Medpor'', and ePTFE (expanded

polytetrafluoroethylene Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene that has numerous applications. It is one of the best-known and widely applied PFAS. The commonly known brand name of PTFE-based composition is Teflon by Chemo ...

), better known as ''

Gore-Tex Gore-Tex is a waterproof, breathable fabric membrane and registered trademark of W. L. Gore & Associates. Invented in 1969, Gore-Tex can repel liquid water while allowing water vapor to pass through and is designed to be a lightweight, waterpr ...

''. 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.Augmentation options
''All About Cheek Augmentation: A Patient Education and Support Network.'' Last accessed 6 July 2009.

Shapes

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.Malar and Submalar Implants: Overview
'eMedicine.com from WebMed''. Medscape. Last accessed 7 July 2009.

Incisions

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 Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...

. Cheek implant surgery is usually performed under sedation or

general anesthesia General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...

and take about one to two hours. Recovery from this surgery usually takes about ten days.

Risks

As with any surgery there is a risk of

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

, postoperative bleeding, formation of a

blood clot A thrombus (plural thrombi), colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of cr ...

, 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 ''Loss of Sensation'', alternatively titled ''Robot of Jim Ripple'' (Russian: «Гибель сенсации» («Робот Джима Рипль»)) is a 1935 Soviet science fiction sound film directed by Alexandr Andriyevsky. Although the f ...

is common, an extended loss of sensation can occur with any surgery, especially cosmetic plastic surgery.

Fillers or injections

Injections to the cheekbones to provide a less invasive and less expensive approach to cheek augmentation. A

hyaluronic acid Hyaluronic acid (; abbreviated HA; conjugate base hyaluronate), also called hyaluronan, is an anionic, nonsulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. It is unique among glycosaminoglyca ...

, such as

Juvederm Injectable filler (injectable cosmetic filler, injectable facial filler) is a soft tissue filler injected into the skin at different depths to help fill in facial wrinkles, provide facial volume, and augment facial features: restoring a smoother ap ...

, can be injected to the cheek area.

Autologous Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogenei ...

fat is considered a "more permanent" option, but all are eventually completely resorbed.

Zygomatic osteotomy

A zygomatic "sandwich" osteotomy is far less common. The procedure is often indicated during reconstructive surgery for

birth defect A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities ca ...

s or traumatic

injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, o ...

. During this procedure, the zygoma, or cheekbone, is separated by bone cuts near the orbital rim and

maxilla The maxilla (plural: ''maxillae'' ) in vertebrates is the upper fixed (not fixed in Neopterygii) bone of the jaw formed from the fusion of two maxillary bones. In humans, the upper jaw includes the hard palate in the front of the mouth. T ...

. The bone is then moved outward and a solid material, such as

hydroxylapatite Hydroxyapatite, also called hydroxylapatite (HA), is a naturally occurring mineral form of calcium apatite with the formula Ca5(PO4)3(OH), but it is usually written Ca10(PO4)6(OH)2 to denote that the crystal unit cell comprises two entities. ...

, is wedged in place to hold the new position of the zygoma.Milrolo, Michael et al. ''Peterson's Principles of Oral and Maxillofacial Surgery.'' 1200-1201
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References

{{DEFAULTSORT:Cheek Augmentation Oral and maxillofacial surgery