I do not recommend cheek implants or fat transfer initially. Since you have questions and concerns, understandably, I recommend you undergo injections of either Perlane or Voluma initially. These products will provide a beautiful result in the hands of an expert experienced injector. The result is temporary and is reversible if you do not find the result pleasing. Following this treatment, you may decide to undergo fat transfer. Again, a Board Certified Plastic Surgeon with experience and skill in fat injections will provide the optimal result. There are risks with any procedure of asymmetry or infection, although these risks are low. You may also try Botox injections in the masseter (lower jaw) to relax the lower cheek area.
Small Silastic cheek implants placed through and Intra-oral approach directly over the maxilla are all that's needed to augment the flat cheek area. Very rarely do we ever see them shift, migrate, get an infection, or develop a serous fluid pocket around the implant. Cheek implants give a very predictable result. For more information, diagrams and our cheek implant photo gallery, please see link below
I think that either is reasonable, and you just need to choose based upon the issues you have brought to light.
Kenneth Hughes, MD
Los Angeles, CA
All approaches work, however all of them have their potential drawbacks. When you smile your cheeks have much more prominence. Would you want them to look overly prominent when you smile? You would have to be seen in person for a proper evaluation.
In over 35 years of doing cheek implants I have, of course, seen problems. With 15 years of fat transfer, I have also seen problems. No problem has been severe enough to cause any permanent damage. Both procedures have some degree of reversibility, especially the cheek implants. If the cheek implants do not give a problem within the first six months, they should not be a problem for most of your life. In later years if you have facial wasting the implants might be more noticeable. Treatment can always be done then. Fat can grow or shrink but carries the versatility of being touched up or extracted as needed.
Thank you for the questions and the photos. You bring up some important issues with respect to the cheek contour and common procedures. Fat grafting, when it works out perfectly, is a fantastic procedure. However, as you suggested, the "take" is not always 100% and may be different between sides. Cheek implants are much more predictable. The additional advantages of implants is that they are a definied shape, and are removable if you change your mind later. The implants are made of a silicone-based plastic and are biologically inert. They are considered safe, and, in my practice, have been a great option for patients. Shifting or movement of the implants is possible but rare. Lastly, you bring up an excellent point about the contour between the upper cheek and lower cheek (buccal fat). In some cases, adding volume to a flat upper cheek can be enhanced by removing a small amount of fat from the lower cheek. This procedure, called buccal fat reduction (cheek slimming) is done through a small incision in the mouth and can be performed at the same time as either of the above techniques for the upper cheek. Best of luck moving forward!
Yes, you are a candidate for cheek augmentation with an implant or fillers. Your cheek area is flat, so you may benefit from the implants. Soft, round cheeks give women a more feminine look. The incision is on the inside of the mouth, so there is no obvious surgical incision.