"Doctor, my cheeks are falling!" This is a comment I hear often in my practice. "I used to have high, full cheekbones and now my cheeks are flat. Are my cheeks falling?"
The facial region is a complex component consisting of skin, muscle, fat and bones, along with multiple nerves that work together to open and close the mouth and eyes and allow us to smile. As we age, gravity is not our friend. Laxity of the skin and supporting tissue causes drooping of the cheeks. The "cheekbones" do not actually fall, but rather the skin, fat and supporting structures start to descend. This descent or laxity of the cheeks and supporting tissues is what results in the formation of jowls along the lower jaw line and a hollow appearance of the cheeks.
Facial augmentation is a significant part of my practice. In a prior blog, I reviewed the topic of chin augmentation. The remainder of this blog will be contributed to cheek augmentation.
Cheek augmentation can be performed both nonsurgically and surgically. Nonsurgical facial augmentation can be performed by using either autologous fat (patient's own fat) or a dermal filler. Cheek augmentation using a facial implant is a more permanent way of enhancing and adding volume and support to the cheeks and overlying soft tissues. A cheek augmentation also results in mild "lifting" of the face and jowls.
Cheek implants are composed of several different forms of synthetic materials. The common types are either silicone-formed implants or porous polyethylene. The silicone implants are usually smooth in composition and the polyethylene ones have a textured surface. I use both in my practice and prefer the textured implants when performing cheek augmentation. Prior to the surgery, I occasionally order a radiograph to evaluate the symmetry of the facial cheekbones or to rule out any boney pathology.
In my practice, the implants are placed under anesthesia, either general or local anesthesia with sedation. I prefer to place the implants through an incision in the mouth. I make an incision inside the mouth, in the region where the upper teeth meet the inner cheek. I create a pocket between the cheekbone and the facial muscles. I frequently use a sizer, which is a temporary implant, that can be placed into the pocket to determine which permanent implant to use. In this manner, I can place a different size or shaped sizer on the right and left to make a decision in the operating room which implant best aesthetically augments the patient's appearance. With cheek implants, I occasionally place a permanent titanium screw through the implant, securing it to the underlying bone to prevent any movement or rotation of the implant. The oral incision is sutured closed and the patient discharged home shortly afterward.
A course of oral antibiotics is prescribed postoperatively. These patients are occasionally placed into a compression facial garment to reduce swelling and to prevent a postoperative hematoma. Immediately after surgery, there is moderate bruising, swelling and tenderness in the cheek regions. You will be instructed to place ice on the cheeks intermittently for the first 24 hours while maintaining a soft diet and not smoking. It is common for movement of the upper lip region to be both sluggish and numb immediately after the surgery. This is a consequence of nerves "stretching" in this region. All healing takes time, and complete uncomplicated healing of the swelling, bruising and numbness can take 2-3 months.