Do cheek implants change your smile, and are they performed under local anesthesia?

In our practice, the cheek implants are placed  below the smile muscles directly over the bone, so they do not affect the smile.  Cheek implants can be placed under local or general anesthesia, however most patients elect general anesthesia for patient safety and comfort.

 Hi, I have performed many facial shaping procedures using dermal fillers, silastic facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  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.  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.  Conversely, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.  While I perform the vast majority of chin implant surgery under local anesthetic, I prefer using a general anesthetic for cheek implant placement which offers a greater degree of patient comfort throughout the surgery.
 Cheek implants can be placed using several different approaches but using a small incision on the inside of the mouth remains the "gold standard" and most accepted manner of placement.  This technique places the silastic "cheek implant" on the cheek bone itself below the tissue covering of the bone in what is called an "implant pocket or space".  The tissues are closed in layers from the inside outward and a double water tight closure is done along the incision line. 
I have placed silastic cheek implants for 30 years in military, SWAT, LE, professional fighters, as well as actors and many regular people who are active.  When placed below the covering of the bone and when the layers of the cheek are closed from the inside out, there is no need for fixation screws or sutures in my humble opinion.  I do ask that all my cheek implant and chin implant patients sleep on a U-shaped pillow for 1 month following the surgery.  In addition, I have had the opportunity on numerous occasions to replace silastic cheek implants (placed by others) that had been screwed into the cheek bone.  During the replacement it was evident that the metal screws pushed right through the soft implant as it was tightened down on the hard cheek bone.  Which makes perfect sense.  So in the long run, these fixation methods alone are no guarantee that the implant won't move.  Proper placement, proper implant pocket creation and meticulous closure of all the tissues layers is what is required in my humble opinion.  The implant will not cause any permanent change in your smile.
Hope this helps.