• Malar: outer upper cheek area giving that chiseled, runway model look.

• Sub-malar: the lower or mid-cheek region to help fill out a sunken in face. The face seems to become gaunt as we age and many people seek this placement for rejuvenative properties.  Although a more natural appearance can be achieved with fat grafting which replaces your lost volume with your own fat stores.  Fat grafting, or other injectables such as Sculptra, Aquamid, etc. can also be used for malar augmentation.  I have had fat grafting and Sculptra, plus a Feather Lift to gift me more prominent cheeks. 

• Malar/Submalar combos: This is as it sounds, a combination of the two above. Some patients desire augmentation in both areas and can get both if they wish it. Please discuss this with your surgeon - view photos of both placements by him or her. Have him or her explain to you the different looks one receives with either placement or a combination of both.

Sizing
The second reason?  Too big or too small of an implant. In common augmentation cases, 4mm thick implants are used.  It is possible that one may need more and these implants are easily ordered as is, custom-ordered or carved from solid medical grade implant silicone or other type blocks to suit your individual needs.  Also, there may be in-office sizers to determine the augmentation size pre-operatively although do not rely on these as they are often hard to place for a realistic preview.

Saline injections can be used and are a little painful but helpful.  They will not give you a superlative idea of definition, but they can let you know what it looks like to have cheeks before you actually get them.

Commuter Imaging is another source of "try-on."  Please see our computer imaging section for more information.

Implant Fixation
The third reason? Displacement, i.e. "shifting."  The main reason implants shift is because of improper pocket formation.  You do not need fixation with screws to hold your implant in place.  A perfectly sized pocket can be made and hold your implant in place.  

For those of you who insist on fixation, titanium screws may be the answer. These screws can be used to secure most solid silicone and other types of malar implants into your underlying bone to fixate the implant and prevent it from shifting or falling within the face.  A few patients report occasional cold sensitivity when screws have been utilized.  This is usually remedied by ascertaining that the screws are placed away from any nerve clusters.

Another option is permanent or resorbable suture fixation. The implant can also be fixated with a non-resorbable (permanent) or resorbable suture material onto the periosteum.  The periosteum is thick and is often used in chin implant fixation.  It can successfully  be used with cheek implants as well.

Scar Capsule Formation
As with any foreign body, a scar capsule may form around the implant. Discuss with your doctor his preferred implant material and brand of choice for further information.  This should not effect the cosmetic results of your cheek implant as it can with breast implants.  Cheek implants are hard and will not distort under the contraction of a fibrous membrane.

The Key To Successful Cheek Augmentation
Most surgeons are able to skillfully place your implants, secure them and send you on your way to satisfaction.  However beware the surgeon who does not stay on the bone. This is important. If the implant is right under the skin it is more palpable and has an increased rate of infection and shifting. They must also make the pocket the correct size.  This is not breast implant surgery where the pocket is made to be roomy, with malar and submalar implants this can cause the implant to heal in place improperly or shift afterwards.  Thus a proportionate pocket must be made to accommodate the implant itself and nothing more.