I'm male, aged 45. I have mild malar hypoplasia and significant submalar hypoplasia. My goal is a fuller mid face, especially either side of my nose where the flesh is thin, sunken and lined (I had acne as a teenager so maybe this led to loss of soft tissue here). Some plastic surgeons have suggested silicone implants, others fat transfer. But will submalar implants improve my anterior cheeks? Is fat better? Or a bit of both? Also how to remove nasolabial creases? Thanks in advance!
Cheek Augmentation: Implants, Fat Transfer or Fillers? (photo)
Doctor Answers 7
The choice of cheek augmentation with implants fat transfer or fillers.
The choice of cheek augmentation with implants fat transfer or fillers is a commonly asked question. In your case it appears that a combined implant that goes over the cheek as well as the sub malar area will give you the best results fillers can be use for the area next to your nose as well as the nasal labial creases.
Cheek augmentation: Cheek implants best option
Cheek implants give the best, most consistent, permanent predictable result. The cheek implants, come in a multitude of sizes and shapes such as malar and sub-malar. They're composed of Silastic, are inserted through an intraoral approach and placed directly over the maxilla, under general anesthesia. In this particular case, Terino malar implants would be best suited for your facial features
Submalar hypoplasia, cheekbones eyelid troughs, nasolabial creases
Various options exist to improve these conditions.
With the advent of Artefil a long lasting filler and the refinements that we have achieved with fat grafting these areas can be safely improved without silicone implants. Using injectables these areas can be corrected with more precision and less chance of a visible or dislodged implant. Fat injected to the malar areas lasts for years successfully in 2/3 of patients.
Artefill when injected twice will improve these depressions as well as the nasolabial folds for many years. Perlane and Radiesse are also good options for these folds.
Please consult in person with an experienced Board Certified Plastic Surgeon prior to making treatment decisions.
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There are several options available to help augment the cheek area. There are advantages and disadvantages to each of them, so one is not necessarily better than the other. Your basic options would be to augment just the submalar area or to augment the submalar and malar areas. The decision between them is really a matter of preference. Augmenting just the submalar area will help primarily with the area you have circled in your picture, but you could also augment the malar area if your preference is also to get a more prominent cheek bone. The options for how to augment would basically be between surgically placed implants or fillers. There are implants that can just be used for the submalar area, implants for just the malar area, and an implant that does both. Fillers could be used as well, and there are several to choose from, including Radiesse and Sculptra, or fat. In regards to the nasolabial lines that you have, normally this is improved when the submalar area is augmented.
Certainly a complete physical examination is necessary to answer your questions. However, based on the photos, the midface area is very weak. As we get older, the malar fat pad shrinks and descends down the cheek, leading to volume loss in this area. I find submalar implants work very well to rejuvenate this area. The implants are placed through a small incision inside the upper lip. They are permanent yet reversible. One can consider other fillers such as Restylane/Perlane, Juverderm, Sculptra etc, which will help although these are not permanent. Fat can be used as well, however one must understand that not all the fat will remain, a portion is absorbed. The nasolabial folds are part of our normal anatomy and are created by the muscles of the face. Therefore they can not be removed, they can only be softened.
Cheek Augmentation: Implants, Fat Transfer or Fillers?
Aesthetically speaking, from the photos provided, the cheeks are flat and there may be malar bags on both cheeks. You can Augment the Cheeks with Fillers (I prefer Perlane) or Cheek Implants. The profile shows a weak chin that can be augmented with a Chin Implant.
Improvement of Midface
There are advantages and disadvantages to several techniques to improve the midface. A cheek lift will decrease the depth of the nasolabial grooves and improve the cheek contour. The lower eyelid margins can be raised at the same time. The cheeks can be augmented to improve projection using fat, fillers, or silicone implants. Even though they are more work I normally prefer implants because they are permanent.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.