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

Cheek

Cheeks constitute the area of the face below the eyes and between the nose and the left or right ear. They may also be referred to as jowls. "Buccal" means relating to the cheek. In humans, the region is innervated by the buccal nerve...

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

Zygomatic bone

The zygomatic bone is a paired bone of the human skull. It articulates with the maxilla, the temporal bone, the sphenoid bone and the frontal bone. The zygomatic is homologous to the jugal bone of other tetrapods...

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

Restylane

Restylane is the trade name for a range of injectable fillers with a specific formulation of non-animal sourced hyaluronic acid . Restylane was the first stabilized hyaluronic acid filler on the market and reportedly has been used in over 11 million treatments worldwide .In the United States,...

, are also popular. Rarely, various cuts

Osteotomy

An osteotomy is a surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum...

 to the zygomatic bone

Zygomatic bone

The zygomatic bone is a paired bone of the human skull. It articulates with the maxilla, the temporal bone, the sphenoid bone and the frontal bone. The zygomatic is homologous to the jugal bone of other tetrapods...

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

Chin augmentation

Chin augmentation using surgical implants can alter the underlying structure of the face, providing better balance to the facial features. This operation is often, but not always, performed at the time of rhinoplasty to help balance the facial proportions...

.

Materials

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

Silicone

Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....

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

Polyethylene

Polyethylene or polythene is the most widely used plastic, with an annual production of approximately 80 million metric tons...

, marketed as Medpor, and ePTFE (expanded polytetrafluoroethylene

Polytetrafluoroethylene

Polytetrafluoroethylene is a synthetic fluoropolymer of tetrafluoroethylene that finds numerous applications. PTFE is most well known by the DuPont brand name Teflon....

), better known as Gore-Tex

Gore-Tex

Gore-Tex is a waterproof/breathable fabric, and a registered trademark of W. L. Gore and Associates. It was co-invented by Wilbert L. Gore, Rowena Taylor, and Gore's son, Robert W. Gore. Robert Gore was granted on April 27, 1976, for a porous form of polytetrafluoroethylene with a...

. Both Medpor and ePTFE are inert

Inert

-Chemistry:In chemistry, the term inert is used to describe a substance that is not chemically reactive.The noble gases were previously known as inert gases because of their perceived lack of participation in any chemical reactions...

 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.

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.

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

Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

. Cheek implant surgery is usually performed under sedation or general anesthesia 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

Infection

An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

, postoperative bleeding, formation of a blood clot, and severe swelling. Asymmetry is a risk with all forms of cheek augmentation. This can occur due to uneven resorption, implant displacement

Displacement (vector)

A displacement is the shortest distance from the initial to the final position of a point P. Thus, it is the length of an imaginary straight path, typically distinct from the path actually travelled by P...

, or shifting. This shift can happen due to swelling, trauma or scarring. Although a temporary loss of sensation

Paresis

Paresis is a condition typified by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it also can be used to describe the muscles of the eyes , the stomach , and also the vocal cords...

 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, such as Restylane

Restylane

Restylane is the trade name for a range of injectable fillers with a specific formulation of non-animal sourced hyaluronic acid . Restylane was the first stabilized hyaluronic acid filler on the market and reportedly has been used in over 11 million treatments worldwide .In the United States,...

 or Juvederm

Juvéderm

Juvéderm , one of the newest of the so-called “injectable fillers,” is used by cosmetic, dermatological and plastic surgeons to soften deep folds and reduce wrinkles in the faces of patients. The substance is largely hyaluronic acid, a substance normally found in the skin, muscles, and tendons of...

, 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 defects or traumatic injury

Injury

-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...

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

Orbit (anatomy)

In anatomy, the orbit is the cavity or socket of the skull in which the eye and its appendages are situated. "Orbit" can refer to the bony socket, or it can also be used to imply the contents...

 and maxilla

Maxilla

The maxilla is a fusion of two bones along the palatal fissure that form the upper jaw. This is similar to the mandible , which is also a fusion of two halves at the mental symphysis. Sometimes The maxilla (plural: maxillae) is a fusion of two bones along the palatal fissure that form the upper...

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

Hydroxylapatite

Hydroxylapatite, also called hydroxyapatite , is a naturally occurring mineral form of calcium apatite with the formula Ca53, but is usually written Ca1062 to denote that the crystal unit cell comprises two entities. Hydroxylapatite is the hydroxyl endmember of the complex apatite group...

, is wedged in place to hold the new position of the zygoma.