Best Way to Fill Apple of Cheek

Question

Does fat transfer have long lasting results in the apple of the cheek? Does a submalar implant fill it up? Whats the best treatment, My cheeks are flat, with strong bone prominence.

Alan B. Brackup, MD, FACS · Answer

As the comments below are reviewed, it's clear there's no one correct answer.  Different surgeons have their favorite approaches that work well in their own hands.  Each of the recommended approaches can achieve excellent results, although each has its own pitfalls.

	Perhaps the greatest longevity with the least risk profile it the use of autologous fat.  I have found it to achieve a very long-lasting result with less risk than permanent implants.  More recently, I have tended towards the deep placement of hyaluronic acid such a Perlane in this region.  It achieve a very natural result that can last a year or longer, with the greatest safety of any approach.  Patient satisfaction is extremely high.

Ron Shelton, MD · Answer

Volumization of the cheeks has become well accepted as we have learned that fat atrophy causes much of the downward shift of the face. Perlane, Juvederm UltraPlus, Sculptra and Fat injections are often done to accomplish this. There are risks with these treatments as there are with cheek implants but the risks are different. Implants can shift, compress nerves and if infected need to be removed. See a plastic surgeon to discuss this.

Houtan Chaboki, MD · Answer

Hi,

	Strong cheek bones with a flat midfacial area may be treated via multiple methods.Several cosmetic options are available to improve volume loss in the cheeks or midface. Volume loss is a natural progression seen with facial aging, or present at young age due to inadequate bone structure. Midface volume loss may also be seen earlier with genetic predisposition, medical conditions, severe weight changes, or medications too.

	 

	Treatment obviously is to add volume, typically. Injectable fillers with hyaluronic acid, Restylane, or Juvederm may be appropriate. Alternatively, longer acting facial fillers such as Radiesse or Sculptra provide longer-term improvement of the cheeks. All these injections are office procedures.

	Other options include fat injections, which have been used for decades for facial rejuvenation. Fat injections have the potential for long-term cheek enhancement. Lastly, cosmetic surgery with a silicone implant or midface lift may be more appropriate in selected patients. Silicone cheek implants are a good option for permanent cheek enhancement.

	There isn't one best treatment for facial plastic surgery procedures. Only after a comprehensive evaluation by a plastic surgeon specialist can he/she help determine appropriate options for you for natural cheek enhancement. Best of luck.

	Dr. Chaboki

Michael Law, MD · Answer

acial 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.

	Moderate enhancement of chin projection in appropriate patients can dramatically enhance the profile, in a manner that is completely natural-appearing. It is remarkable how increasing chin prominence in some patients will reduce the apparent prominence of the nose, and restore an overall sense of harmony and balance to facial features.

	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.

William Portuese, MD · Answer

Fat transfers have very inconsistent results and are best avoided in the facial area because of the ensuing asymmetries of resorption. It is just not a consistent procedure. The submalar implants when placed are inserted up on an intraoral approach above the upper tooth roots and placed directly over the bone. If they are too large they can be removed and a smaller one inserted and vice versa. The implants give a very consistent result and can actually be removed if the patient ever wanted to have them removed. A submalar implant is placed directly below the malar area over the lower portion of the cheek.

Elizabeth F. Rostan, MD · Answer

Depending on several factors including skin thickness, amount of correction needed, budget, size of the rest of the face and presence or absence of tear troughs (need to fill right under the eye). I will choose Radiesse, Sculptra or restylane or Juvederm. If only mild correction is needed then one of the hyaluronic acid fillers such as restylane/perlane or juvederm is often a great choice. If more volume is needed, I will use sculptra or radiesse. If I plan to do a significant amount under the eye, inside the orbit, then I will usually use Restylane there as I think Restylane has best results and least complications inside the orbital area.

Douglas J. Mackenzie, MD · Answer

There are many options, and it is best to have a consultation with a plastic surgeon who is comfortable with several techniques. If you have good bone structure, then a cheek implant, that mimics structure (bone) is probably not what you need, and it is probably best to increase the soft tissue volume. Injectable products that do this well include Sculptra and Radiesse. Fat injection is another option that works well, albeit with an element of unpredictability as already mentioned.

Mohsen Tavoussi, MD, DO · Answer

Although the cheek implants can have some complications, generally they are the best way to enhance the midface area. If done correctly by an experienced surgeon, they should not move and nerve injury should not occur. The result is immediate and long lasting. Fat is an alternative but survival is unpredicatble. More often than not, will have to repeat the procedure in order to achieve the final result. Fillers are good but temporary.

Elan B. Singer, MD · Answer

they can move, they can get infected and while the risk of surgery is low, nerve injury is always possible. The general trend is to move away from these implants and instead go with fat transfers or injectables like Radiesse or Sculptra. There are pros and cons to each of these procedures--fat transfers can last years but they are somewhat unpredictable and therefore may need to be repeated once or twice to get the final result. Facial fillers such as Radiesse or Sculptra are much more predictable but they don't last as long (Radiesse about 10 months and Sculptra 2-3 years after 3 treatments). I suggest finding a local plastic surgeon who is familiar with all of these modalities and going in for a consultation. Good luck!

Richard W. Fleming, MD (retired) · Answer

There is no "best way" to fill cheeks for every patient. The surgeon and patient have many choices including permanent implants, or injectables such as fillers and the patient's own fat. I discuss and provide all alternatives with every patient. There are advantages and disadvantages of each.

Best Way to Fill Apple of Cheek

Answers (13)

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