How Cheek Augmentation (Cheek Implants) Surgery Is Performed

First, you will have monitoring pads attached to you so that the surgical team can properly monitor your vital statistics before, during and after your operation.  When you are brought to the operating room, electrodes will be plugged into these pads which are connected to the monitoring equipment.  However, your heart and oxygen saturation may be monitored before you are brought into the O.R. at the same time your IV is inserted.

I.V Insertion
You may or may not have already been hooked up to the saline IV drip and are awaiting the O.R. to be prepared for your surgery.  Other surgeons wheel you into the O.R. and insert your IV then.  If you had been given an oral sedative or valium prior you usually could care less what they are sticking in you.  If you haven't been given a sedative, the initial first few minutes until you are anesthetized may be stressful.  

Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time.  It's the initial placement of the IV catheter that may sting a bit.  Some patients get it in the crook of the elbow, some the hand.  I dislike the ones in the hand as it's a nasty place for a bruise to be, at least with the arm you can hide it, it all depends upon your veins though.  So if your veins are not very prominent this can be a problem.  Some patients even have to be catheterized in the neck. 

After the needle is injected into the vein, it is pulled out and a little Teflon tube is left in your vein.  This intravenous tube is called a catheter.  However many people consider the whole access system a catheter.  Let's call the access system a 'catheter hub' for simplicity.  This hub usually contains the catheter, a needle, a flashback chamber and tubing connected with a luer lock. 

The hub acts as an injection port and is taped to your skin to keep it from getting knocked out.  Medications can be injected into the body via this port or be connected the tubing to allow automatic infusion of drugs and intravenous fluids with a computerized drip system.  In short, the IV is for a saline drip to keep you hydrated and also acts as a vascular doorway for medications, many times including anesthesia.  You may or may not receive some medications to help you relax or feel sleepy at this time.  This can help with pre-operative anxiety if you were not given an oral medication to do so.

Monitoring Equipment
Regardless of the order and manner in which they insert your IV, after you are placed on the operating table they will talk to you for a minute or two and hook you up to the heart monitoring and oximeter machines, possibly wrapping your legs with compression cuffs and other final preparations.  Your vital signs will be monitored, including your blood pressure, body temperature, pulse rate/heart beat, and your breathing rate -- all very important factors to determine if you are okay while under anesthesia.  The O.R. staff will also check your blood pressure.

Anesthesia Types Used In Breast Reduction Surgery
If you and your surgeon have chosen an IV Liquid Sedative, they will either manually insert medications with a hypodermic into a Y site or injection port along the length of the silicone tubing connected to your catheter hub/IV or more than likely your anesthesiologist will attach a bag of anesthetic or use a computer-controlled drip system.  The computer system automatically infuses a few drops of anesthetic every few seconds into a drip chamber where it mixes with the saline.  The drip crate can also be controlled via the roller clamp.  Flow regulators can also regulate the flow rate.  

When the anesthesiologist releases the roller clamp the mixture starts heading towards your body.  The effects of the anesthesia are felt soon after injection or opening the roller clamp--afew seconds in fact.  It feels like heat going into you veins then creeping up your arm; then it jumps from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized. 

If you have chosen Gaseous-state anesthesia (Twilight, Gaseous General) Your mouth and nose will be covered with a mask and you will usually be told to count back from 100.  You will usually remember getting only to about 96 before falling fast asleep.  Then, the anesthesiologist will more than likely intubate you.  Intubation usually involves an endotracheal tube down your throat to deliver gaseous anesthesia to your lungs.  However, some surgeons give you a little IV sedation and then intubate you and switch over to gaseous sedation.  Both of these maneuvers eliminate the horrible experience of having a tube shoved down your throat while you are awake, which is unheard of in this day and age.

Another option is with the use of a laryngeal mask airway (or LMA).  This is a lot like the older intubation for General but there is a shorter tube and a little balloon the size of your two thumbs at he end.  The tube holds your tongue down and of the way so it does not obstruct your breathing and the balloon inflates and bocks fluid from entering your windpipe either from saliva or stomach acid and makes a seal so the gas can be delivered to your lungs.  It is basically like a diaphragm for your windpipe.  With the older intubation you have the pleasure of having a tube down your throat but you don't usually remember it going in.  You may wake up with a raw throat with either but it is usually less so with the LMA.  You may wake up with an irrigated and dry throat regardless because canned or cylinder air (scubadiving tanks as well) is d-r-y.  There is no moisture in these tanks.  It is your turbinate structure (three little fleshy flaps in your sinuses) inside your nasal structure that mostly warms and humidifies the air which you breathe.  When you have to humidify your air, your body needs more moisture.  The saline drip will assist in this as well.

Another option is with silicone tubing which is placed in the nose, however this is rarely used as surgeons and anesthesiologists prefer that the windpipe be protected and the tongue held down and throat firmly held open for longer procedures.  Be sure to ask your surgeon which method he will be using if you are interested.  Regardless of which method, the gaseous anesthetic is mixed with oxygen and this is how you will breathe during your surgery.  

You may then be marked with a magic marker type pen for the implant placement areas and incisions if your placement is to be performed extra-orally.  

Sterilizing The Surgical Field
The O.R. staff will then scrub your face and neck (and other areas if you are having other procedures) with a 7.5% Betadine Surgical Scrub.  The O.R. staff will then rinse off the area with sterile gauze soaked in saline and then paint your surgical area with the 10% Betadine Solution which resembles a brownish, iron-colored liquid.  This will sterilize the area by killing surface bacteria, fungi, protozoa, viruses and yeasts.  A common bacteria found on the skin is the naturally occurring Staphylococcus aureus, or simply Staph) and decrease your risks of an infection.  

The Surgery
You will be injected with a solution of Lidocaine, epinephrine and saline.  The epinephrine is a vasoconstrictor. This will impede your skin's ability to bleed excessively by narrowing the bore of the blood vessel.

The incision will be made in the predetermined placement, the implant situated directly on top of the cheek bone (or if need be, right below it) and checked for the proper look suitable for the patient's features.  It is possible that it may be removed and further customized several times during the operation.  The implant either sutured or screwed into place. Sometimes percutaneous sutures are used.  This is where they stick partially out of the skin and can be removed later on by tugging gently on them after they have partially dissolved within. They can also be sutured with dissolvable stitches inside the surrounding tissues.  Even still, the implants may not be sutured in at all, only the pocket, relying on your body's collagen to secure into place.  If no implant/sutures are used you will more than likely have tape or a head wrapping that is worn at night to help it heal properly in the face.  

The surgical team then performs a sponge and instrument count and your surgeon then closes your incisions with, more than likely, a non-dissolvable type suture.  You may have an antibiotic-soaked piece of gauze placed between your upper molars and, gums and your inner cheek and perhaps a pressure dressing placed around your head such as you would see in a face lift patient or a neck liposuction patient.  If you are not familiar with this look it involves wrapping a dressing around the top of your head to underneath your chin, sometimes slightly over your ears.  Of course there may be differences in surgical technique depending upon the preference of your surgeon.

You are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released.  This is dependent upon the individual but may take up to two hours. You have had injections of local anesthesia and this will numb the inside of your mouth.  Take care not to bite the inside of your mouth as you will not feel it if you lacerate the mucosa.  Your face may feel tight and quite tender as the anesthesia wears off.  You may even feel emotional or upset, this will depend upon your body's reaction to anesthesia.  You may also experience rigors, or "shivering."  This may feel uncontrollable and  is usually from the medications -- more than likely epinephrine that is used as a vasoconstrictor.  The recovery nurse usually has wrapped you in a warm blanket but if not, request one.  It certainly makes things more tolerable. You may even be fortunate to have heating lamps.

Some patients feel nothing different although if you have had General you may feel a little sick, hopefully your surgeon gave you something to lessen this.  Your prescribed medication should alleviate this pain and discomfort.  However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately.  You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.

For Injectable Products
There is sometimes an injection into the nerves cluster which will numb the lower half of the face.   Injections of whatever product was discussed beforehand will be implanted via a hypodermic.  You may be asked for input and given a hand mirror.  Do remember that there may be swelling if these products are suspended in saline.  A majority of the swelling will subside within a few hours if this is the case.  Products such as injectable hydroxyapatite or hydoxyl-apatite like Radiance FN (or Radiesse), Reviderm Intra, Artecoll and fat grafting. You will more than likely be able to drive yourself home if only local or regional anesthesia is given.  If you were given an oral sedative it is unlawful, and dangerous, for you to drive yourself home.