Best Way to Fill Apple of Cheek

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.

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.

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.