Artefill is not approved by the FDA for cheek implants, and should not be routinely advocated for that purpose.
Cheek augmentation requires a relatively large volume to achieve an effect. Depending on the position of the augmentation, it may be above the zygomatic (cheek) bone or the midfacial muscles of expression. The poly methyl methacrylate beads contained in Artefill get into tissues. They do not stay exactly where you place them.
Large volumes of synthetic substances injected into the face are particularly worrisome. The body cannot develop a blood supply in the injected material to defend itself against the bacteria that are in the region.
I have personally surgically removed many such deposits of many different semipermanent fillers, some available only in Europe (Aquamid for instance) and replaced them with LiveFill (fascial fat grafts). The surgical removal is difficult and fraught with problems because the material can migrate around deep nerves and cause chronic pain syndromes; surgery to remove the material will necessarily involve dissection around the nerves and is by its nature incomplete since the material infiltrates the tissues themselves. In the cheek the infraorbital nerve is particularly vulnerable.
If you develop an infection years later, or a chronic inflammatory reaction, you may have no way of removing the Artefill. Likewise if the Artifill beads migrate over time and the appearance changes or becomes deformed, there is no way to remove them completely.
If however you have a silastic cheek implant, these implants can typically be removed from inside the mouth easily and completely and replaced with a different implant or LiveFill (fascial fat grafts) if they should become visible or the patient does not like their shape. Many patients in our practice have LiveFill grafts placed in well defined pockets. These completely autologous (natural to the patient) grafts maintain their shape and volume over time as studied by 3-D CT scans and clinical photographs.
As with many treatments, the correct treatment is not necessarily the cheapest or most convenient.
