You’ve likely heard the saying “Everything old is new again,” to explain the cyclical trends in fashion and art. Still, the same could be said for some plastic surgery procedures—like the recent uptick in requests for the lip lift and facial implants, including cheek and jaw implants. For example, cheekbone implants have been around since 1956. They were further improved upon and popularized 40 years ago by Dr. Edward Terino and, later, Dr. William J. Binder, who developed customized implants in a wide variety of sizes and shapes, to fit many different faces, before largely falling out of favor. Yet according to the American Society of Plastic Surgeons, there were only 10,427 malar augmentations (aka cheek augmentations) performed in 2000 versus 108,189 in 2020. So it seems a new generation of patients is returning to a tried-and-true procedure, says Dr. Jed Horowitz, a board-certified plastic surgeon in Newport Beach, California. “It’s nice that people are rediscovering techniques that are useful. And I think cheek implants [can be] useful,” he says.
Why cheek implants are becoming more popular
Cheek filler has been the predominant choice for patients seeking to add more volume to the cheek area until recently, says Dr. Ben Talei, a board-certified plastic surgeon in Beverly Hills, California. “In the past year or two, there’s been a movement toward [more] radical surgery,” he says. Dr. Ariel N. Rad, a board-certified plastic surgeon in Washington, D.C., has noticed the shift in his practice, where he regularly uses cheek implants as part of his arsenal to refresh and improve a patient’s facial structure, explaining, “Surgeons have a much better understanding of facial anatomy now than 10 years ago.”
Perhaps propelled forward by our recent WFH culture, many people have taken advantage by getting more invasive cosmetic work because they can often recover without anyone knowing they’ve had anything done. In addition, Dr. Rad sees patients who recognize the “one and done” benefits of surgery results that will last a lifetime. Moreover, Dr. Talei says that many patients are opting to go under the knife instead of seeking out noninvasive procedures like facial filler due to trends they’re seeing on social media. “More and more people have wanted these strong cheekbones, and gonial angles [at the corners of the mandible] augmented, so they get more definition,” he says.
There’s also a growing backlash to “filler fatigue”—the undesirable consequences of too much filler over time, says Dr. Horowitz. He says patients are wary of becoming overstretched and ending up with doughy-looking skin. They’re better informed about the phenomenon after hearing many celebrities coming forward with their own stories of having their filler dissolved. In addition, other popular facial surgeries are likely contributing to the trend, points out Dr. Talei. Procedures like buccal fat removal, where fat is removed from the lower cheeks to contour the face, are often paired with filler or cheek implants to add additional height and definition to the upper area. But “we’re only a few years into this phase, so nobody knows how this trend is going to go,” he cautions.
Where cheek implants are placed
The submalar area is right beneath the lower eyeline, where the cheekbone begins. Typically, patients may notice some volume loss here as the boney areas of the face begin to degrade and the fat and skin of the cheek area descend, due to age. So this is when patients may request submalar implants, although some people are born with a deficiency in this area, often resulting in proptosis or bulging eyes, says Dr. Horowitz. Placing implants there can combat the look of aging and illness often associated with a sunken appearance around the eyes. The malar region begins right below the submalar area, where the cheekbone sits. Requests for augmentation to this area are usually made by patients in their 20s and 30s who want a more angular, defined appearance, says Dr. Talei.
Depending on their ultimate aesthetic goals, patients can opt for one or both implants. Both implants can be placed via incisions made within the mouth, says Dr. Talei. These implants are typically held in place with a stitch to the soft tissues until a scar tissue capsule forms (similar to what happens around a breast implant). However, they may migrate due to facial movement, so the preferred method among most surgeons involves anchoring them in place with a 1.5 mm titanium screw to the bone.
Pros of cheek implants
All cosmetic surgery decisions should always be thought through carefully, and getting cheek implants is no different. But cheek implants are an easy add-on procedure when you’re already getting another facial surgery, such as a facelift, says Dr. Horowitz. “Adding volume back into the face now is almost routine for [all] facelifts,” he says.
While hyaluronic acid fillers may have an initial cheaper barrier to entry and are arguably much easier to put in, they must be repeated yearly to maintain results. They’ll also slowly get absorbed by the body, so you’ll likely begin to notice less volume and projection over several months. So while results may be impressive, they’ll never achieve the effects that can be achieved with implants that mimic the firm contour of bone, says Dr. Rad.
Unlike breast implants, malar implants are lifetime devices that should be permanent. “The implants can be trimmed and carved, so they’re different sizes and shapes that can be used to get your desired effect,” explains Dr. Horowitz. While off-the-shelf implants are cheaper alternatives, Dr. Rad says, “custom implants open up infinite possibilities” for rejuvenation and cosmetic improvements. “Think of it as buying a suit off the rack versus bespoke [suiting],” he says.
Since everyone’s face is asymmetrical to varying degrees, newer technology and a surgeon with a discerning eye can help improve irregularities, ensuring that patients end up with more predictable results, explains Dr. Talei. “In the past 10 years or so, we’ve been using CT, computerized tomography, to measure out someone’s face and look at the bony deficit on each side and create three-dimensional customized implants,” he says.
Understanding the risks of cheek implants
According to Dr. Talei, cheek implants pose risks similar to those of other surgeries: infection or bleeding at the incision site. While this is rare, it’s thought that getting dental procedures before getting cheek implants could create an entryway for bacteria to enter the body. It’s best to schedule dental work a month before or after cheek implants. In addition, implants can sometimes cause edema, or long-term swelling.
If your doctor places implants too large for your face, Dr. Talei says, there can be more serious complications. “What happens when you place a large implant [in the cheek] is, it puts too much pressure on the bone under it. You get something called resorption. It starts pushing against the bone, and over the next five years, the bone actually gets smaller. So now you’ve lost all that projection, and you’ve become asymmetrical.” Patients are then forced to redo their implants to correct these changes to the face, meaning they have incurred higher costs and additional risks related to another surgical procedure. Other issues include temporary or permanent loss of sensation in the cheek area and nerve damage to the infraorbital nerve (the nerve responsible for feeling in the lower eyelid), the side of the nose, and the upper lip.
Uneven placement between both sides of the face is another possible complication that many patients report dissatisfaction with. “You have to get the left and right side to be the same, and if the face is already asymmetric, that’s a little tricky,” says Dr. Horowitz. Moreover, cheek implants that aren’t secured with a screw may shift over time, due to facial movement. A study published in JAMA Facial Plastic Surgery on complications related to facial implants found that one-third involved migration or extrusion. In addition, 41% of these complaints were related to malar implants, the most reported for any type of facial implant.
How much do cheek implants cost?
Cheek implants can cost anywhere from $1,200 to $1,500, depending on the physician’s surgical fees, geographical location, and whether the implants are custom made. Although this can be a significant investment for some, permanently augmenting the face may make more sense for the right candidate. “If it’s a minor augmentation, I tell people just to do filler. If it’s a medium augmentation, you can do the implant,” says Dr. Talei.
Who is a good candidate for cheek implants?
Cheek implants can substantially improve the contours of a patient’s face, when placed correctly (accounting for things like asymmetry), and replace lost volume due to things like aging. “If the cheeks are very flat or very deficient, these patients benefit from having those cheeks augmented in one way or another,” says Dr. Horowitz. Patients should be healthy nonsmokers already cleared for surgery or undergoing another facial procedure. It’s not that difficult to put in cheek implants while a patient is already getting a rhinoplasty or facelift, he says. While patients can choose to have a stand-alone surgery for cheek implants, they can save money on costs like anesthesia and the operating room by combining this procedure with other surgeries.
What if you want to remove your cheek implants?
Cheek implants are meant to be in place for life, but much like other facial implants, they are removable. Taking out the implant should be a reasonably straightforward procedure, provided the implants are not too large and weren’t placed too far in the past, says Dr. Talei. “If [you’ve placed] a large implant, you’re likely to have bone resorption underneath the implant because there was pressure on it. So that means you’ve lost bone volume. For that reason, some people can’t fully remove them—[instead] they have to replace the implant with a smaller one,” he says. In addition, a large implant may stretch out the skin, which will need to be addressed following the implant’s removal with another procedure, like RF microneedling or a facelift.
If patients decide to remove implants 5 or 10 years down the line, another issue that may occur is natural aging compounded with some skin stretching from the implant. He says this can be improved with fat grafting to replace lost volume or a procedure to lift the skin. However, younger patients with elastic skin who need to remove their implants should see the skin bounce back without any long-term changes.
The bottom line
“If you’re ever going to do any facial implant, you really want to go to somebody who does them a lot and does them tastefully. It’s easier to find a surgeon who does a chin implant well, but if you’re doing cheek implants, you really need to find a specialist,” says Dr. Talei. Make sure to ask to see before and after images of patients—and don’t solely rely on social media, where photos can be doctored or have filters.
“These are all tools to get patients the best results we can. I think you have to look at each patient individually [and then] pick and choose,” says Dr. Horowitz. Cheek implants, done correctly, have the ability to rejuvenate and improve the contours of the face. Just be aware that they’re meant to be with you for the long haul, so choose your surgeon and ultimate aesthetic goals wisely.
