Do cheek implants change as you age? Should I get fat grafts instead?

Question

I am considering getting cheek augmentation as my cheeks do not reach my nose. When I smile my cheeks are very full and round, but at rest they are very flat, which makes my nose look larger in comparison. I would like a result that gives me the smile face at rest. I am concerned about how implants change over the years, as I am only 19, so do not know how my face will change as I age. Fat transfer is an option but is that riskier or safer? Would fat transfer solve the same problem? Which is better?

Jed H. Horowitz, MD, FACS · Answer

Hello katherineCheek implants are  permanent, with fat injection lasts for several years, a board certifie plastic surgeon would help u make the right decision.

Nelson Lee Novick, MD · Answer

Cheek implants themselves are permanent and do NOT themselves change with age. However, you are only 19 years old and you can expect significant age-related changes in the surrounding normal skin and underlying fat over the next few decades, which, owing to these facial contour changes, will likely necessitate more surgery to remove the current implant and replace it with a more appropriate implant at that time. For this reason alone, I would be reluctant to suggest this surgical route. Fat transplantation sounds attractive, however, the promise of permanent results are often not realized and in many cases the transplanted fat does not last any longer than an off-the-shelf injectable volumizing fillers, and besides the procedure tends to be relatively expensive and involves what amounts to two surgeries: one to harvest the fat from the belly, hips or buttocks and the second procedure of injecting the larger fat particles through large-bore cannulas. The use of volumizing fillers, such as Voluma XC, which I would use in my NY office and Stylage XXL, which would be my choice in my Israel satellite facility, where a far greater number of regulatory agency approved fillers are available, In experienced hands, nonsurgical cheek augmentation in this fashion should take no more than ten minutes  and the results typically engender and immediate "Wow!" response. Make sure that you consult with a board certified aesthetic physician. Best of luck.

Jason Emer, MD · Answer

No, cheek implants should not change as you age, but fat grafting can also be used to improve the cheeks. Fat transfer technique is what is important for successful fat transfer. I recommend water-assisted fat harvesting which gives pure fat to transfer and combine with platelet rich plasma (PRP) to get the most viable and sustainable fat cells. I then combine with Sculptra, depending on area, to improve final results. recommend getting a formal evaluation with an expert to determine which technique works best for you. Best, Dr. Emer

Barry L. Eppley, MD, DMD · Answer

Cheek implants structurally do not change over time as the material is stable. Whether in the very long-term when you are much older your overlying soft tissues will change around the implants to any significant degree is an often debated question. But in most cases with well placed cheek implants that are not oversized and fit the bone well, these are not issues of any consequence.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You are asking if cheek implants change as you age, and if you should get a fat transfer instead for cheek augmentation. You indicate you are only 19-years-old, but your cheek volume does not reach your nose when not smiling, making your nose look larger, and you find your cheeks to be flat.
I can certainly guide in the absence of a physical exam, and also without a photo for reference. I’m a Board Certified Cosmetic Surgeon and Fellowship-trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I perform cheek implant surgery, often at the same time as a facelift, surgical fat transfers to the cheeks, as well as perform non-surgical cheek augmentation with fillers, using a special technique called Structural Volumizing.
To first answer your question, cheek implants do not change in shape as you age, however, the bone structure where the implants are placed certainly does. There is significant volumetric loss of bone, muscle, fat, and soft tissue as we age, so your face actually gets smaller. As bone diminishes with aging, the silicone cheek implants will eventually not fit properly, and the edges of the implant may be seen through the skin. While cheek implants to last long-term, they are not actually permanent because at some point they won’t fit your face.
You are asking if fat transfer is a better option. Fat transfer is an option, but you must realize that 30-70% of grafted fat can be absorbed by the body, so you will need at least two surgical procedures. Grafted fat is an unpredictable material to work with, due to absorption, not taking to a blood supply, or not retaining its desired shape, so additional surgery may be needed for best results.
The more predictable procedure I prefer for cheek augmentation these days is using a long lasting hyaluronic acid filler such as Juvederm Ultra Plus and Juvederm Voluma. These thicker fillers can last 1-2 years, and are designed for the cheeks, jawline, and other facial areas that have little to no movement. I place these fillers deeper, atop the bone structure and between the muscle layer, so they don’t migrate to look soft and doughy, but look natural and give structure to the face. 
That said, you are only 19-years-old, so I would have to perform a physical exam to determine if you have a genetic volume deficiency in the cheeks and face before recommending any volume augmentation treatment. While it is possible you have one, it is often the case that people are a little overcritical with their own appearance, and see things in themselves that others don’t see. At 19, you are at the peak of your youthful appearance, so any procedure must be considered and evaluated carefully. I hope you found this information helpful. Thank you for your question.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, silastic facial implants (cheek implants, chin implants and lip implants), liposuction and/or facelifts for over 30 years.  Non smiling resting photos of your face from the front and side would help in the evaluation.  
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  When the front portion of the cheeks are either flat or concave, cheek augmentation with precise placement of a dermal filler or using silastic cheek implants (for a permanent enhancement) of the proper aesthetic size/shape/positioning will create full, round cheeks that will feminize the entire face. The cheek implant procedure is performed under a general anesthetic in about 30 minutes using a small incision on the inside of the mouth.  I have used silastic cheek implants for 30 years and do not find it necessary to use screws or sutures to hold the implants in place.  Proper creation of the implant pocket combined with complete closure of the surgical area, in multiple layers, prevents the implant from moving.   We do ask that our cheek implant and chin implant patients sleep using a U-shaped airline pillow for 1 month following the procedure.  After that, the implant is secure and will not move.  Full healing can be expected between 3-4 months post-op however, full activity can be resumed at 1 month.  Out of town or international patients are cleared to fly home in one week following the procedure.   Cheek implants when properly performed offer the most natural cheek augmentation.  The face ages with more youthful shape when cheek implants are present.  It's an urban myth that they look odd as the face ages, in fact cheek implants age well as if they were the cheek bone itself.  They remain the "gold standard" in shaping and augmentation of the cheeks offering a vastly superior result both in shaping ability and reliability compared to fat injections or transfer (discussed further below).
There are many faces that have excess fat over the cheek area which hides the "true" shape of the cheeks below.  In addition to obstructing the cheek shape, this excess fat will sag prematurely as it is pulled by gravity at an accelerated rate versus a face without excess fat in the mid face.  Removal of the excess fat, with liposuction, is key when properly shaping the cheeks with cheek implants.  I have used this in combination with cheek implant surgery for 30 years.  In my experience these procedures when combined in a face with excess fat in the mid face are extremely safe, effective and reliable in the aesthetic results they produce.
 I have performed many Chin Augmentations using chin implants for over 30 years.  From the photos, your chin is weak.  if the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face. 
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.   I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

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