Cheek Implants or Permanent Filler - How Do I Decide?

For cheek augmentation, how do I decide between getting cheek implants or having a permanent filler injected into my cheeks?

Doctor Answers 11

Real cheek implants are permanent

This is a simple question......If you have undersized cheek projection and you want a permanent solution that looks and feels natural find a surgeon with real experience in cheek implants. Fillers on the other hand are all temporary, and actually hard to make even looking....true they don't involve surgery and have almost no complications but its a poor trade off to have to do something once or twice a year at significant expense just to maintain your cheek bones. Cheek implants done by an experienced surgeon  take 45 minutes under local anesthesia and in 10 days most swelling is gone. Complications are rare and the results are permanent....before you get fillers make sure you consult a surgeon who does cheek implants and can show you numerous results of his work

Fat Injections or Fat Grafting Provide a Safe, Natural Looking Alternative to Implants

Facial Implants for facial bone augmentation

A wide variety of facial implants are currently available for the enhancement of the skeletal elements of facial aesthetics. The most commonly used facial implants are used to enhance the profile of the chin and the cheeks. Facial implants very widely not only in shape and style, but also in terms of the materials from which they are fabricated.

My preference is to use structural fat grafting, as much as possible, to enhance facial features. In many cases, the need for a solid implant can be eliminated by the careful and meticulous grafting of a patient's own fat. While the incidence of complications with facial implants is not high, certain problems may develop which require implant removal including infection and implant migration. Bone resorption (bone loss) has also been reported below solid facial implants. Neither of these problems are an issue with structural fat grafting.

The only setting in which I currently use a solid facial implant is for chin implant augmentation. Some patients with a 'weak' chin profile can be adequately improved by structural fat grafting alone. However, when the chin protrusion needs to be enhanced by a half centimeter or more, a chin implant is absolutely required. I prefer to use a soft, flexible, anatomic chin implant that conservatively enhances the anterior projection of the chin in profile. The chin implant is placed through an incision hidden underneath the chin, an area where many people already have a scar from a fall in childhood.

For enhancement of the cheek bone area, I rely exclusively on structural fat grafting. Careful and meticulous fat grafting not only avoids some of the potential complications of solid cheek implants, but it also allows more precise 'customization' of the aesthetic improvement that can be obtained for each individual patient. It is also my opinion that structural fat grafting produces a more natural-appearing enhancement of the cheek area than what is generally achieved through the placement of solid implants over the cheekbone.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 98 reviews

Cheek Implants or Permanent Filler - How Do I Decide?

Cheek implants are permanent and can result is a large degree of augmentation. They will cost less over the long term. Downsides are possible complications such as resorption or nerve compression. Fillers are easier to perform with less down time but generally are temporary, so they will have to be repeated. Fat grafting is one of the best fillers for cheeks as it is more permanent and has minimal complications.

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Filler vs Implants in the face

The decision on whether to use a soft tissue filler or a solid implant for volume augmentaiton of the face is purely based on whether the problem is related to skeletal underdevelopment (hypoplasia) or soft tissue deficiency.  The former may treated with an implant and the latter with a soft tissue filler. However, the surgeon needs to be aware of the patient's goals and recovery. The patient may choose to use a filler to correct a skeletal problem to have a faster reovery but a temporary result. Trying to compensate for skeletal loss with a filler can only work to a certain extent, howerver. If too much filler is added, the face loses definition and has a soft doughy look. Also, there may be other bone related issues contributing to the problem. Make sure you go to a surgeon who is facile in all techniques so the pros and cons of each can be discussed equally.

Stephen B. Baker, MD
Washington DC Plastic Surgeon
4.0 out of 5 stars 9 reviews

Permanent injectables have no place in medicine

In regard to cheek implants over time there is fat-loss under these devices,  The  implants then develop a significant depression below them that seems visually very peculiar  , Using injectables to create naturally appearing cheeks is not simple but is very rewarding,Permanent fillers  should not be used in that they can cause inflammatory reactions and move over time. I prefer Juvederm and it should be used to create  the lateral ramus of the cheek and not a ball like structure under the eye 

Arnold W. Klein, MD (in memoriam)
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Cheek Implants vs. Permanent Fillers

Cheek implants are the Gold Standard, compared to a permanent filler. Implants are also a reversible operation, adding a feature not available with injectables.

Once you have the permanent injection, it cannot be removed.

A temporary filler, or even sterile water, can be injected into your cheeks, giving you an idea of what a cheek implant would look like on your face.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 25 reviews

Fillers vs Implants for Cheek Augmentation

Other than fat transfer, there is no other safe permanent filler. In particular - STAY AWAY FROM LIQUID SILICONE INJECTIONS as they can lead to serious complications even years later. Lipoinjection or Fat transfer I believe is a great way to help correct asymmetry of facial soft tissue deficiencies as well as to augment the cheek bone area giving the illusion of high cheek bones. It is a great technique with long lasting results which can be added to when there is continued loss of native fat in this area as part of the aging process. Of interest the transfer fat that survives tends to stay better than the native fat as it retains the nature of the donor site rather than the recipient site. Since the advent of fat transfer the number of implants I use and recommend has decreased significantly as this is such a good technique. That being said the advantage of Cheek Implants is that they are predictable and permanent. 

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Cheek Implants, Cheek Augmentaion, Cheek Enhancement

This is a great question that I answer during patient consultations each and every week.  I have performed Cheek Augmentation with Cheek Implants for over 20 years.  Here are the issues with using a permanent filler, in the face to shape the cheeks:

  • The current Fillers that are available should be placed in the subcutaneous fatty tissues
  • these fatty tissues shift with gravity and aging towards to nose and mouth creating the nasolabial folds and jowls
  • if permanent fillers are injected over the cheek area, within this fatty tissue layer, it will eventually shift as described above
  • because all fillers can create granulomas, permanent fillers can and do cause granulomas that require surgical removal resulting in a scar on the face

 In my opinion, there are to many drawbacks to using permanent fillers for Cheek, Chin and Jaw Line Augmentation with the current fillers.   I prefer to use temporary fillers in these areas (Radiesse and Perlane) or to use Cheek and or Chin Implants made of silastic.  When a permanent filler is available that can be injected directly onto the bone that will become part of that bone, I will add that filler to my treatment regimine and not until.


Be sure that the plastic and cosmetic surgeon, you select, understands and follows the proper aesthetics of facial beauty for the creation of a naturally, more attractive face.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 17 reviews

Cheek Implants or Permanent Filler

The cheek augmentation is known as really easy to perform and a safe, effective procedure, restoring balance, proportion and a younger appearance. Most surgeons nevertheless believe that thorough medical assessment and realistic expectations should be prerequisites.

From my practice I know that it is not common when cheek enlargement (whatever it will be) or cheek implants are requested as an isolate procedure, more often it goes together with other facial rejuvenation procedures.
When planning cheek implants we always should to take in mind the whole combination - whether it a face lift or neck lift , and the final purpose of course. It may be correction of the jowls, of mid face or sagging neck, of eyelids and so on. The aim may be regaining lost volume of a face, skin resurfacing and wrinkle management. So every condition and patients expectations are special, and sometimes unique, there is is no one and the same decision that can be aplied to every situation.
From my part I can say that I try to use patients' own fat whenever it is possible, even for big volumes. Though complications after cheek implant surgery are rare, they can not appear with fat grafting.
Hope this will help you..

Ercan Karacaoglu, MD
Turkey Plastic Surgeon
5.0 out of 5 stars 17 reviews

Fillers have many advantages over implants for cheek augmentation

Having strong cheek bones defines a face and makes it attractive.  Most models and actors have great cheek bones.  Most of us ordinary people have average cheek bones, and a few of us are unlucky enough to have deficient cheek bones.  With deficient cheek bones, your face may appear bottom heavy, your nasolabial folds may deepen, and your face may develop deep hollowing and dark circles.

Cheek implants are very effective at improving this problem, but they can have a high complication rate.  They also involve a moderate amount of swelling.  For a surgeon to be very good at using these implants they must have a lot of experience with them.

Fillers on the other hand are easier to customize, have a fraction of the swelling, and allow the patient to participate in the sculpting of their face.  Most fillers are not permanent at the time I'm writing this response, but Radiesse lasts 6-9 months and ArteFill may give longer lasting results. 

For an example of using facial dermafillers, please click the link below.

David C. Mabrie, MD
Bay Area Facial Plastic Surgeon
4.5 out of 5 stars 73 reviews

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.