The photos you have posted tell that while you have correctly described a' weak structured mid face' skeleton, you do not appreciate the aesthetics required to make an informed decision. Let me explain about cheek aesthetics to everyone interested in good cheeks. By the way 'aesthetic' is defined as pleasing the senses. In other words when you see someone with an attractive mid cheek it gives you a pleasurable feeling to see their lovely face, as it makes the person look robust, healthy and attractive. Two distinctly different bones sie by side form the midcheek skeleton. The inner cheekbone is the maxilla, a soft bone that houses the growing secondary teeth. After they erupt the front of the maxilla shrinks, which makes a flat face even flatter!The outer cheekbone is the zygoma, which is a hard and durable bone that is responsible for facial glamour of women and the rugged handsomeness that you could obtain. The projection of the zygoma needs to be assessed in 3 directions. To the side, where it should match the side of the face, eg the temple. Forward projection, as you demonstrated in the photo and finally and most importantly, the oblique projection, which you did not demonstrate. You need a 3/4 view photo to show this . Also the oblique projection should be high over the existing bone and not below the bone, to allow the concavity that helps define the curvature of the cheek. To help you decide on the final shape and if it suits your face I perform a 'fluid test'. That is, in the office dilute local anaesthetic fluid is injected as a dress rehearsal to expand the tissues to mimic the approximate result. You hold a mirror to evaluate the result in the different parts of the cheek. Of course you need to approve the look, so the surgeon has your involvement and feedback. You are looking at a lifelong result from this surgery, so all the arguments about quick and easy with quick recovery are of little relevance. The missing structure is the cheekbone. Soft tissue fillers and fat injections are soft fillers which cannot define the shape as does solid, bone like, material. Part of the function of the zygoma is to provide attachment and support of muscles and ligaments, which attach to the periosteum, the membrane around the bone.When solid implants are placed, a pocket is made on the outer surface of the bone and the implant placed between the bone surface and the periosteum that has been elevated. In the process, the origin of the muscles and ligaments is positioned outward to match the situation of a person who naturally had that shape of the bone. Whereas soft fillers, they just sit like a blob on the muscle without lifting its origin.. I don't have space to compare the 3 main solid implants, silicone and Porex, which are inserted as a solid reshaped implant. One of the difficulties with them is their back surface is flat and does not have the exact contour of the bone surface beneath. Whereas, my preferred material is coral, yes South Pacific coral that is processed in Irvine California to become pure mineral hydroxyapatite with the same crystalline structure as facial bone.It comes as granules which are inserted using a small syringe containing blood, which forms a clot holding the granules and the clot granule mixture is moulded to the desired shape. This sets and after 2 years, the patient's bone grows into the coral. There is no risk of rejection whatsoever and infection is not a concern as it is with the other implants.While there the surgeon can also enhance the shape of other areas of the facial skeleton, the temple and jawline especially.I speak from the experience of having performed over 500 midcheek skeleton enhancements using coral. Unfortunately only a few US Plastic surgeons use this, although the product (ProOsteon 200) was developed in the US as was most of the research.Reference:Biologic Behavior of Hydroxyapatite Used
