Written by Dr. Julian De Silva
Dr. De Silva featured and quoted in Harper’s Bazaar article “The 10 most wanted Hollywood cheekbones in Harley Street.”
High prominent cheekbones and a well-defined jawline, are coveted facial features and characteristics of beauty. Some people are naturally born with these high cheek bones, often characteristics seen in model portraits. In addition to natural cheek prominence, with facial ageing the cheeks become flatter as a consequence of loss of facial volume and reduced facial fat. Cheek augmentation surgery can improve facial contour and balance out facial features. There are several ways in which volume to the cheeks can be restored, including both non-surgical and surgical treatments. Although non-surgical treatments by definition avoid surgery, the use of temporary fillers to the cheeks that require constant replenishment are not ideal from a long-term perspective. The use of silicone implants to the cheeks gives an enhanced cheek bone appearance. The surgical insertion of these implants is a common procedure that can be done on their own or in conjunction with other treatments such as a facelift or chin augmentation.
According to Dr. De Silva a Facial Cosmetic Surgeon in London, there is artistry in determining the suitability of cheek implants to a persons’ face, choosing silicone cheek implants over the alternative such as fat augmentation. Both procedures are different options that correct subtle differences in the face. Silicone cheek implants are good at correcting skeletal deficiency, which can be seen with various facial parameters such as a negative vector (in-turning angle between the eyelid and cheek). The use of autogenous fat transfer is good at correcting soft tissue volume loss particularly in facial aging. This technique involves harvesting fat from around the navel, processing the fat to concentrate the cells, and re-injecting very small amounts into focal areas in the cheek. Approximately 50% of the fat injected survives over a 5-year period, however the fat absorption does vary between individuals. A cheek implant is usually made of a medical grade silicone and does not absorb and will last forever. There is a small risk of the implant becoming infected or moving in which case it is relatively easy to remove.
The surgical technique to insert a cheek implant involves a small hidden incision in the inside the upper lip. A pocket is created for the implant, underneath the soft tissues of the cheek (hidden from view), the implant is customized and sculpted as needed and re-inserted into the cheek pocket, and fixed with stitches. There are several different types of implants that are chosen based on the persons face and natural requirements. The implants can be inserted onto the cheek bone (Malar Implant), below the cheek bone (Sub-Malar Implant). Or a combination of the two (Combined Malar-Sub-Malar Implant).
What are the surgical techniques for insertion of a Cheek Implant?
There principle for the insertion of Cheek Implants is through a small pocked 1-cm inside the mouth (Intra-Oral) this results in a hidden incision. There are often asymmetries between the two sides of the face, and Dr. De Silva utilises specific implant sizers to chose the best size for the right and left cheeks to give a natural augmentation. Dr. De Silva may shape the cheek implant to a person’s unique anatomy, every person’s cheek bones are different and requires a different 3-D enhancement to give the best result. Natural variation in the zygomatic arch, infra-orbital bones and position of the eyelid relative to the cheek, mean that optimal proportions differ in all faces. There is a degree of artistry in all individuals’ faces that each surgeon interprets and adds to, much like each chef has their own individuality to every dish they serve.
Are there alternatives to a Cheek Implant?
An alternative to cheek implants is the use of non-surgical volume enhancement with fillers (e.g. hydroxyapatite, hyaluronic acid fillers). Although these can be use effectively to give volume they are both temporary and when used in excess can create a ‘fake’ puffy appearance. In some patients these are a good option in the first instance as they are temporary. According to London based cosmetic expert, Dr. De Silva recommends Silicone Cheek Implants in some patients in preference to other forms of cheek augmentation as it is longer-lasting, safe and effective. Other volume augmentation including fat is less predictable and less effective for replacing boney deficiency. Other implants including Medpor and Polytetrafluoroethylene (ePTFE) are available, however are associated with a high risk of infection and integration with soft tissues compared to silicone. A high-grade silicone cheek implant should last a lifetime, rarely they can move or become infected, and can easily be removed in these rare occurrences.
How long is the recovery from Cheek Implants?
The results of the surgery are immediate, although local swelling can make the cheeks look too large for the first two weeks. The swelling and local bruising takes about 2-weeks to mostly resolve, and the great majority of patients return to work after one week. Occasionally the swelling can persist for longer such as 6-weeks, and medications are used to speed up the resolution of the swelling. The movement of the upper lip can be suppressed for the first couple of weeks aft surgery and spontaneously resolves. Dr. De Silva uses a small 1cm hidden incision inside the mouth and dissolvable stitches that naturally fall out in the first few weeks. Patients are advised to take a soft food diet for the first couple of days and to avoid strenuous activity 3 weeks after the cheek implants. Most patient have minimal if any pain, which responds to oral analgesia.
Will I have bruising after Cheek Implants?
The surgery to insert cheek implants requires placing the implant over your own cheek bone, which enables the implant to be placed in a natural position mimicking natural bone. Dr. De Silva specialises only in facial surgery and uses minimally invasive techniques to insert the cheek implant and where necessary 3D camera to evaluate positioning. As a consequence most patients have minimal if any bruising after cheek implant insertion. Patients who have undergone previous surgery with scar tissue have a greater risk of bruising and swelling owing to a change in the natural anatomy of the cheek and scar tissue.
What are the risks or complications of Cheek Implants?
All cosmetic surgery has some risks, generally speaking cheek implants are very safe. With cheek implant surgery there is a small risk of infection, bleeding, allergy, movement of the implant and of bone absorption over time under the cheek implant. Dr. De Silva advises against cheek surgery in patients with increased risk of infection.
Dr. De Silva uses technical skills to reduce the risk of implant movement or dislocation, by sculpting a narrow and deep pocket for insertion of the cheek implants under the facial muscles that make movement of the implant minimal.
Dr. De Silva has treated patients with rotated implants by other surgeons, and uses a novel technique to prevent implants rotating in his patients by securing all implants with a specialised mini-screw. This screw is approximately 8mm in size and prevents any movement of the cheek implant long-term. The screw is specialised and cannot be seen or felt once in place, it is not detectable on airport security although would be seen on an x-ray or CT scan of the head.
What type of anaesthesia do I need for cheek implants?
Cheek augmentation can be completed with local anaesthesia, Dr. De Silva prefers his patients to have sedation anaesthesia, also known as twilight anaesthesia, this enables his patients’ to have a comfortable and relaxed experience with a fast recovery. With sedation Dr. De Silva’ s patients are able to go home within 30 minutes after the procedure. General anaesthesia can be used for cheek augmentation it is not necessary as the recovery is longer.
How do you treat a cheek implant infection?
Although the insertion of cheek implants is usually straightforward it can relatively rarely by complicated with infection. There is a natural flora of microbes that live in your mouth, and the nature of inserting cheek implants through the mouth and thereby hiding incisions means there is a small risk of infection with every cheek implant. An infected cheek implant will typically result in symptoms including fever, swelling, discomfort and pain. With an early infection, antibiotics can be effective in curing the infection without further treatment and without removal of the implant. Some surgeons have described washing of the implant with antibiotics in conjunction with oral antibiotics as an effective method of treating an early infection. However in the relatively uncommon situation of an apparent cheek implant which has become infected, if the implant is not improving with antibiotics, the treatment will require removal of the implant, allowing a period of time for the infection to resolve, followed by re-insertion of a new implant 3-months later. Dr. De Silva utilises silicone cheek implants which are relatively straight forward to insert and remove, however other types of implant (including Medpor) can be challenging to remove as the body can heal with the implant making it difficult to remove.