1. What is Cheek Augmentation surgery?

Originally cheek (malar and submalar) implants were first used for reconstruction for birth defects and trauma related incidents.  Now, they are routinely applied aesthetically to enhance a person's cheeks or to create symmetry within the facial structure from a "weak cheek" by birth.  With cheek implants or augmentation the face is transformed into chiseled features that are very aesthetically pleasing.

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2. What are cheek implants made from?

They are normally made from hard Silicone :

"As an implantable biomaterial it is most commonly used in the form of the dimethylsiloxane polymer which is a large molecule of repetitive units containing silicon, oxygen and methane, ((CH3)3SiO-[(CH3)2SiO]x-Si(CH3)3). The extent of polymerization determines the viscosity of dimethylsiloxane and hence its physical state: liquid, gel or solid. Short, linear chains of polymethylsiloxane result in oils or gels...

"...Heat and catalysts increase branch length and form solids. Silicone polymers are easily contaminated with heavy metals, low-chain-length polymers, and other impurities during the manufacturing process and their refinement requires specialized filtration and sterilization. Only Medical grade silicone is approved for implantation in the human body". Grand Rounds - Advanced Biomaterials 

Although, many medical device companies are manufacturing newer types (both solid implants and injectables) which are made from expanded polytetrafluoro- ethylene (ePTFE), rigid polyethylene, and hydroxyapatite (processed coral).  The rigid polyethylene implants can be screwed into place into the bones of the face to prevent shifting of the implant post-operatively.  The (ePTFE) implants are designed to be porous so that the tissues can attach themselves to the implant to prevent shifting.  There are Mersilene implants, carvable blocks, PMMA, MMA and more.  Please refer to the Augmentation Options section to read of these materials. Discuss with your doctor which implants he or she prefers and why.

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3. What does a typical Cheek augmentation consultation entail?

First off, your doctor will discuss your goals with you and he will explain what can be achieved realistically.  The usual goal is to augment a lacking cheekbone structure.  Although, some of you may want to change the structure of your face dramatically for that "cat walk model" cheek bone look.  Discuss with your surgeon the goals and general result you would like to achieve. It is all individual.  Just like you!

Your doctor will take into account your facial dimensions and natural face shape.  There are many types of Malar  implants.  The placement as well as the size of the cheek implants will be determined by you and your doctor.  Don't be afraid to speak your mind during this time.

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4. How is Cheek augmentation surgery performed?

The Cheek operation is most frequently performed using Light Sleep Anesthesia, General or Twilight.  Light Sleep Anesthesia is the use of medicines to induce a state of relaxation and a light sleep, General can be gaseous or liquid state - you can read more in the Anesthesia Section.  After your arrival additional medications are given intravenously which induce a profound state of relaxation.  Patients will usually sleep during the operation.  Much of the time patients have very little memory of the operation itself.  After this state is achieved then medicines are given to produce numbness of the surgical area.  Some surgeons find that this type of anesthesia (Light Sleep) is most frequently preferred by patients as it causes almost no recovery necessary from the anesthetics themselves unlike general anesthesia which may produce nausea after the surgery. 

This procedure takes from 1 to 1 and 1/2  hours to perform.  It may take longer if you choose to have chin and cheek implants as well.  Depending upon your facial structure the incisions will be placed as inconspicuously as possible within the hairline or within the mouth for cheek implants.  Some doctors even place the incisions inside the lower eyelid area.  The risk of infection is higher if an incision is placed within the mouth area but with proper post-operative care this risk can be decreased.

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5. What are the different techniques in performing a Cheek augmentation?

There may be surgeons who only wish to use a certain implant type or a certain incision.  Surgeons should give you a choice, as the updated techniques are less scarring than the previous ones.  The doctor may prefer an oral approach where the only incisions are placed within the mouth area.  No visible scars are made and the  oral incisions heal much faster.  However, oral techniques sometimes are plagued by a higher rate of infection.  Especially in those patients with problems such as plaque build up, general poor dental hygiene and smoking.  There are also intra-ocular (through the eye, specifically the lower eyelid) and intradermal where an incision is made within the hairline.

Check with your doctor on the preferred technique that he utilizes.  He may very well prefer the traditional methods out of not being aware of the newer ones or he may very well offer only the newer ones, with the thought that the older techniques are "out of date".  This subject varies from surgeon to surgeon.

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6. What should I expect post-operatively?

Although, there is normally no extensive pain related to cheek implantation, pain medication is prescribed beforehand. Your surgeon may also recommend pharmaceutical grade Arnica montana or Bromelain to reduce swelling and bruising.  Possibly even Bromelain, Vitamin K or others.  You may feel a degree of numbness that will normally disappear within 1-3 months.  You may continue to wear a support brace while you sleep to allow your tissues and implant to heal in the desired position and prevent shifting in the first few weeks,

Don't be alarmed at the presence of bruising and swelling.  The swelling will begin to disappear within the first 5 to 7 days.  Many patients return to work with the help of camouflaging cosmetics at about 5 days post-op.  The swelling resembles inflammation of wisdom teeth or their removal and sometimes this excuse is used at "the office".  Although please realize that the swelling may be apparent for months and the defined, chiseled look that you so desire may not become evident for quite a while.

Things to be alarmed about that are not normal:

• Temperature elevation greater than 101 degrees
• Sudden swelling or sudden discoloration
• Hemorrhage
• Increasing redness and tenderness of the wound edges indicating infection
• Allergic reaction to drugs
• Shifting of the implant

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7. When will the sutures be taken out and does this hurt?

The sutures, if any, will be removed in approximately 5 to10 (sometimes 3 to 5) days.  Your face will be swollen for the first few days - this is normal. T he removal should not hurt extensively although your surgeon may feel the implant through your facial tissues and this may hurt a little.  The swelling should very much dissipate after the first two weeks.

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8. Will there be scarring? If so where will the scars be located?

This depends on the incision choice by you and your surgeon.  It is quite possible to have either one of these implants inserted with no visible scars whatsoever.  Ask your doctor if he is familiar with the intraoral incision locations and what he thinks about them.  Ask him if he is aware of the inner lower eyelid incision for cheek implants which results in NO visible scars and any infection is a rarity.  Although ectropion is at risk here.  Ectropion is a condition where your lower lids are pull down or gape.  If you should develop ectropion, further surgery will more than likely be needed to correct it. Which could lead to more risks and more cost to you, the patient.

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9. Is there a lot of swelling involved with a cheek implants?

There will be some considerable swelling associated with the trauma to the tissues.  Especially if there were screws involved.  Bone trauma may hurt a little more than just tissue trauma so take this into account when you decide on the technique.  Although, it is hardly enough pain to dissuade you from making an "incision decision."  Be advised that you will look like a chipmunk for a while and that the chiseled definition will not be apparent for a few months.  Please go into this surgery well informed because many re-operations or removals are due to patients not being able to handle the swelling.  You are adding with cheek implants - be prepared for swelling.  However, in many patients final results can been seen at around 7 months post-op.

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10. How long is the "down time" for this procedure; how long should I expect to be out of work?

You can expect to resume regular activities in about 1 to 2 weeks.  Although exercising should be reserved for after the third week.  It really is individual but the swelling can be quite pronounced involving cheek augmentation surgery.  There is bruising and of course a support will be worn at night to alleviate tissue stress and to support the healing tissues correctly.  I wouldn't make any plans to attend any weddings or other functions where you will be high profile for at least 4 weeks.  Most patients return to work within a week.

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11. When will I be able to see the results?

The results are immediate, although you may think that the implants are far too large at first glance.  Give your mind time to recognize the difference in swelling and augmentation.  Most patients are very satisfied with the augmentation results as long as they are aware of what to expect beforehand.  Unless, of course, there is shifting or surgeon error regarding the placement and size for the patient's individual face.  However, in many patients final results can been seen at around 7 months post-op.

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12. What are the risks of cheek augmentation?

There is a chance of infection, ematoma (blood clots), seroma, numbness from nerve damage and hyperpigmentation (permanent discolorations) caused by the bruising.  There is the risk of implant shifting which results in additional surgery to reposition the implant.  There is the chance of your disapproval which may result in a re-do or removal.  There is also a chance of asymmetry from the tissues healing differently.

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13. What is Arnica montana or Bromelain, I have heard that these homeopathics reduce swelling and bruising? Which is the best kind to take?

Arnica montana
also known as: Mountain Tobacco, Mountain Arnica, Common Arnica, Leopard's Bane and Sneezewort
plant family: Asteraceae 
type: Herbaceous perennial
parts used: Roots and flowers
description: Arnica montana or Leopard's Bane is a perennial herb, growing close to the ground. The leaves form a flat rosette, from the center of which rises a flower stalk, 1 to 2 feet high, bearing orange-yellow flowers. The rhizome is dark brown, cylindrical, usually curved, and bears brittle wiry rootlets on the under surface.
habitat: Indigenous to Central Europe, in woods and mountain pastures, although it has been found in England and Southern Scotland. 
warning: This herb should NEVER be taken in raw form. This plant, like many medicinal plants if ingested, can cause intestinal bleeding, abdominal cramping and sickness. Homeopathy is the medicinal use of tinctures and suspensions using herbs and other plants and should never be consumed without proper preparation. Only respectable homeopathic remedies and tinctures should be consumed. 

Arnica montana has been used in Europe for centuries to treat swelling, soreness and bruising.  This product is often misunderstood when confused with ingesting the arnica plant in its raw form. When properly prepared, Arnica may significantly decrease the healing time or the appearance of such.  There are many formulations from different companies. Sublingual (under the tongue) types are the most often recommended for plastic surgery.   

Please see our recovery store  for more information.

habitat: Indigenous to southern Brazil and Paraguay, The fruit is now grown all over in green houses and in the fields of Spain, Guatemala, Hawaii and more. The pineapple is a tropical plant and thrives in hot, humid places. Although it can survive cold snaps, it is not recommended for the more northern areas if intended to be grown outdoors.

Bromelain is an anti-inflammatory formula containing the proteolytic enzyme from the stems of pineapples. Proteolytic enzymes are capable of dissolving proteins. It is most often used after sports injuries, to relive edema and after surgical procedures to help with swelling. 

ALWAYS ASK YOUR SURGEON FIRST BEFORE TAKING ANY MEDICATION.

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14. How long do cheek implants last?

Standard cheek implants were designed to last your lifetime.  Especially if the implants are the harder variety and screwed into place, your risk of shifting is very minor.  Although anything having to do with inserting metal into bone run the risks of bone infection and bone deterioration.  However, most "bone screws" are manufactured of titanium and just develop calcifications around the screws, if that, and nothing more.  Then again, everything is dependent upon the individual and as you should know there is no "never" or "definite" in medical science.

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This page was last updated: 07/22/2006