Flat Cheeks After Accident

Hi JenLA,

Sorry to hear of your major facial injuries. Cheek augmentation may be required after the initial facial fracture repair due to decreased bone structure and facial volume. Once fractures heal, the cheeks can further be augmented with silicone facial implants or facial fillers. These silicone implants are placed via small incisions inside the mouth. Generally, one waits for at least 6 months from the initial surgery before considering such further procedures. Implants are placed by a variety of surgeons. Only after a comprehensive evaluation can a surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki

 

 

Yes, you should go to the original surgeon and if he does not do cheek implants as part of his practice see another experienced surgeon for a second opinion.

The surgeon that performed the major operation to reconstruct your face is intimately knowledgeable with your particular anatomy and healing.  An oral and maxillofacial surgeon is certainly qualified to address your current issue.

There may be residual post bony fracture reasons for your flat cheeks. Certainly implants are one option.  If however, the soft tissue and skin injury caused soft tissue contraction, then a better option might be fat grafting.  You might ask your surgeon to sort out the reasons for your current appearance and assess their comfort in addressing the cosmetic deformity.  If for some reason he/she is not comfortable in facial implants or fat grafting, you certainly have myriads of options in Los Angeles.

I trained and spent signficant time in LA.  Other options in LA I can personally recommend for this type of problem include Drs. Mark Berman, Kenneth Steinsapir, Mehryar Taban,  Ronald Strahan, Jonathan Hoenig, and Jay Calvert.

Flat cheeks after a cheekbone fracture can be addressed through unilateral or bilateral cheek implants.  If both cheeks are flat then augment both cheeks a silastic implants.  These are placed through a gingival incision just above the upper tooth roots and inserted directly over the bone to augment a flat area.  If only one cheek bone has been fractured, then an implant it is put in on that side to balance with the original opposite side.  These are usually performed under general anesthesia.  It is best to have a surgeon perform these who has performed a lot of them and has excellent experience with that procedure.  

Many times after extensive facial fracture repair that involves the midface, the prominence of the cheeks may be diminished. This can happen even with the most accurate realignment of the fractured bone segments. This occurs due to soft tissue thinning from the trauma of the accident and the surgery. Cheek implants can be a good secondary reconstructive procedure. It is important to get the right style and size of cheek implants to get a good result. Your original surgeon would be well qualified to perform this surgery and getting her/her opinion is a good place to start. It would be expected that there would be scar and even some plates and screws in the path of re-entry over the cheeks but this does not prevent a good cheek augmentation outcome.

Going back to your original surgeon is always a reasonable alternative as are implants. However, if the implants are not something that you want to commit to at this time you might try a filler such as sculptra. You can get a reasonable amount of volume without ever having surgery. However, not permanent.

That would certainly seem like a logical choice as long as the original OMF surgeon is well experienced in using Cheek Implants.  IMHO, there is a tendency to be confused about the aesthetics of the cheeks and this sometimes carries over into selection an incorrect style, size and shape of cheek implants for the cheek augmentation.

First consult with your original surgeon who took care of you after severe facial injuries. He/she probably does implants, but if not will refer you to a colleague for augmentation.

I place cheek implants or even fillers to make the cheek bone(s) more prominent and maybe correct some asymmetry that you may have after your accident. What would help you best we could discuss on a consultation.