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

cheek The cheeks () 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 inside of th ...

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 ), also called cheekbone or malar bone, is a paired irregular bone, situated at the upper and lateral part of the face and forming part of the lateral wall and floor of the orbit (anatomy), orbit, of t ...

. 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 hyaluronic acid (HA). In the United States, Restylane was the first hyaluronic acid filler to be approved by the U.S. Food and Drug Administration (FD ...

, are also popular. Rarely, various cuts to the

zygomatic bone In the human skull, the zygomatic bone (from ), also called cheekbone or malar bone, is a paired irregular bone, situated at the upper and lateral part of the face and forming part of the lateral wall and floor of the orbit, of the temporal fos ...

(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 intended to give a more youthful facial appearance. There are m ...

or chin augmentation.

Implants

Materials

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

silicone In Organosilicon chemistry, organosilicon and polymer chemistry, a silicone or polysiloxane is a polymer composed of repeating units of siloxane (, where R = Organyl group, organic group). They are typically colorless oils or elastomer, rubber ...

. 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 bott ...

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

polytetrafluoroethylene Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene, and has numerous applications because it is chemically inert. The commonly known brand name of PTFE-based composition is Teflon by Chemours, a corporate spin-of ...

), 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.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 (; : bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of Prokaryote, prokaryotic microorganisms. Typically a few micr ...

. Cheek implant surgery is usually performed under sedation or

general anesthesia General anaesthesia (UK) or general anesthesia (US) is medically induced loss of consciousness that renders a patient unarousable even by painful stimuli. It is achieved through medications, which can be injected or inhaled, often with an analgesi ...

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 tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

, postoperative bleeding, formation of a

blood clot A thrombus ( thrombi) is a solid or semisolid aggregate from constituents of the blood (platelets, fibrin, red blood cells, white blood cells) within the circulatory system during life. A blood clot is the final product of the blood coagulatio ...

, and severe swelling. Asymmetry is a risk with all forms of cheek augmentation. This can occur due to uneven resorption, implant

displacement Displacement may refer to: Physical sciences Mathematics and physics *Displacement (geometry), is the difference between the final and initial position of a point trajectory (for instance, the center of mass of a moving object). The actual path ...

, 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.

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 glycosaminog ...

, such as

or Juvederm, can be injected to the cheek area. Autologous 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 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 can range from mild to severe. Birth de ...

s or traumatic

injury Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants. Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with ...

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

maxilla In vertebrates, the maxilla (: maxillae ) 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. The two maxil ...

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

hydroxylapatite Hydroxyapatite ( IMA name: hydroxylapatite) (Hap, HAp, or HA) is a naturally occurring mineral form of calcium apatite with the formula , often written to denote that the crystal unit cell comprises two entities. It is the hydroxyl endmembe ...

, 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