Hi, I have performed many Cheek Augmentations, using cheek implants, for the past 30 years. When properly placed, cheek implants do not require sutures or screws to hold them in place and should not move or shift. This procedure does require extensive experience to properly select the right size, shape and thickness of cheek implant as well as close all lanes of the cheek tissues. Silastic cheek implants, in my opinion, are not only very safe and highly effective at creating facial shape but are the "best" tolerated implant used in plastic & cosmetic surgery. It's important to note that using a metal screw to attach a soft implant to the hard bone surface will just result in the screw puncturing through the much softer cheek implant. It's not only not required but a useless endeavor in my humble opinion. Non smiling photos, of your face, from the front and side would help in the evaluation. Following the beauty principles outlined in my book on face and body beauty, 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. Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.Hope this helps.