What would fix my flat, recessed midface? Malar or zygomatic arch implants? (Photo)

The two most common areas targeted for augmentation are the malar and the submalar areas, or a combination of the two.  Malar implants increase the projection of the malar eminance, the most prominent part of the cheek bone. How prominent this point is on anyone is mostly determined by genetics and stable through time.  Augmenting the submalar area adds volume under your eye.  We all lose volume in this area with time, and restoring that volume adds a youthful look and can support your lower eyelid. Based on the limited photos I would say submalar augmentation should be the focus of your augmentation, but a wider picture would help to see how your cheek bone projection to the side balances you face.  You would need a lot of filler to get the same affect you would with a cheek implant.  Implants typically last forever, and while some day years and years down the road you may want to add some filler on top of the implant, your cheeks will always look better than they would without the implant.  Most surgeons will exclusively use either silicone or medpore implants and give you many reasons why one is better (I use almost all silicone), but in reality they have similar safety profiles.  Implantech is one of the biggest implant manufactuerers, you can see the wide variety of implants they make on their site.Hope that helps, Dr. Rolfes

Voluma can help.  It can be as quick as a 10 minutes and a painless procedure with an experienced injector.  For your medial cheeks it is safer to use a cannula injection so make sure your physician is experienced with cannulas.  Also, make sure you choose a physician who specializes in injectables, such as a cosmetic dermatologist or a plastic surgeon who spends a lot of time doing injectables (if they do surgery most of the time they won't have as much experience with filler as someone who does it every day.)  Also make sure you pick someone with an artistic eye who will give you a natural look.

The assertion that surgical cheek implants are permanent is technically correct, but not quite the complete story. The implants are themselves permanent, but the soft tissue around the implant may undergo dramatic age-related volume loss with the passage of time to the extent that what might have looked just fine immediately following the insertion of the implant may not look so a decade or more afterward--changes that may in fact necessitate a separate surgical procedure to remove the implants. Alternatively, we are fortunate these days to have robust volumizing fillers whose effects may last up to two years after which additional volumizing filler can be added to conform with any changes that may have occurred via the passage of time. Nonsurgical cheek augmentation in experienced hands takes only about ten minutes to perform, engenders little to no significant downtime, and the results are characteristically immediate and give rise to a "Wow!' response. Before embarking on relatively expensive implant surgery and downtime, you may wish to consult with an experienced board certified physician to discuss these issues in depth. Best of luck.  

Hello and thank you for your question. Based on your photographs, you are a great candidate for malar enhancement.  This can be done in one of two ways.  Voluma is an injectable filler which can be injected into the malar region as a temporary filler.  Malar implants can be placed as a permanent way to gain volume in the cheek.  I always use medpor implants with screw fixation.  Silicone malar implants tend to have a high rate of malrotation over time.   I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.


Best wishes and good luck.


Richard G. Reish, M.D.  FACS

Harvard-trained plastic surgeon
 

Your pictures demonstrate an infraorbital-malar deficiency for which standard cheek implants or isolated zygomatic arch implants are insufficient. You would need custom designed infraorbital-malar implants to adequately cover your midfacial skeletal deficiencies.