Written by Dr Julian De Silva
High prominent cheekbones and a well-defined jawline are coveted facial features and characteristics of beauty. Some people are born with these naturally high cheekbones—characteristics often seen in model portraits.
With facial ageing, the cheeks become flatter as a consequence of volume loss in the face and reduced facial fat. There are several ways in which volume to the cheeks can be restored, including both non-surgical and surgical treatments.
Cheek augmentation surgery can improve facial contour and balance out facial features. The use of silicone implants to the cheeks gives an enhanced cheekbone 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.
Although non-surgical treatments avoid surgery, the use of temporary fillers to the cheeks that require constant replenishment is not ideal from a long-term perspective.
According to Dr De Silva, there is artistry in determining the suitability of silicone cheek implants over alternatives, such as fat augmentation, for a persons’ face. 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 patients with facial ageing. 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, fat absorption does vary between individuals. A cheek implant is usually made of medical-grade silicone, 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.
An alternative to cheek implants is the use of non-surgical volume enhancement with fillers (e.g. hydroxyapatite, hyaluronic acid fillers). In some patients, these are a good option in the first instance as they are temporary.
Although these can be use effectively to give volume they are both temporary and when used in excess can create a ‘fake’ puffy appearance. Other volume augmentation, including fat, is less predictable and less effective for replacing bone deficiency.
Dr De Silva recommends silicone cheek implants to some patients in preference to other forms of cheek augmentation as they are longer-lasting, safe and effective. A high-grade silicone cheek implant should last a lifetime, as rarely do they move or become infected, and are easily removable.
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 after surgery, but this 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 well to oral analgesia.
The surgery to insert cheek implants requires placing the implant over your own cheekbone, which enables the implant to be placed in a natural position mimicking the natural bone.
Dr De Silva specialises only in facial surgery and uses minimally invasive techniques to insert the cheek implant, and where necessary a 3D camera to evaluate optimal positioning. As a consequence, most patients have minimal bruising after cheek implant insertion.
Patients who have undergone previous surgery will have scar tissue which poses a greater risk of bruising and swelling owing to a change in the natural anatomy of the cheek.
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 deep, narrow pocket for insertion of the cheek implants under the facial muscles, which renders movement of the implant minimal.
Dr De Silva has treated patients with rotated implants by other surgeons. He uses a novel technique to prevent implants from 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.
Cheek augmentation can be completed with local anaesthesia, although 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 and a faster recovery than from general anaesthesia.
With sedation, Dr De Silva’ s patients are able to go home within 30 minutes following the completion of the procedure. General anaesthesia is not typically used for cheek augmentation due to the risks it carries. Plus, the recovery time is longer before patients can go home.
Although the insertion of cheek implants is usually straightforward, on rare occasions it may be 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 gives rise to a small risk of infection.
Typically, an infected cheek implant will result in symptoms such as 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 the implant with antibiotics in conjunction with oral antibiotics as an effective method of treating an early infection in cheek implants.
However, in this relatively uncommon situation, removal of the implant is usually advised if the infection is not improving with antibiotics. New implants may be reinserted after 3 months.
Dr De Silva utilises silicone cheek implants which are relatively straight forward to insert and remove. However, other types of implants (including Medpor) can be challenging as the body can heal and integrate with the implant, making it difficult to remove.
Renowned expert in Facial Cosmetic and Plastic Surgery. Signature techniques in Blepharoplasty, Rhinoplasty and Facelift surgery. Expert in revision surgery and in natural looking results
