Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years. 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. I have performed many Cheek Augmentations, using cheek implants, for 30 years and do not use or recommend sub-malar implants for the following reasons. A sub-malar implant is as its name suggests, placed below the malaria or cheek bone. This means that the entire front section of the cheek bone itself will not be augmented, yet following the beauty principles outlined in my book on face and body beauty this is the primary area that's required to properly contour the cheeks. This is why I use malar implants that are a specific shape and size to aesthetically shape the "entire" cheek bone. Properly placed malar implants, in the hands of an experienced plastic & cosmetic surgeon who's performed many cheek implant surgeries, are very well tolerated with minimal issues. My experience is that surgeons who over estimate the complications associated with cheek implant placement tend not to perform that procedure often which might explain their lack of interest in offering that procedure. I advise patients that it's best to have cheek implant surgery with a surgeon who's comfortable with performing the procedure.
Think of facial beauty as something that "must" address all layers of the face including the skeletal structure of the cheeks and chin, the overlying SMAS muscle, amount and position of subcutaneous fat and finally the degree of skin laxity. It's an "urban myth" that pulling tissues over flat cheeks and a weak chin can create a beautiful or handsome face. Similarly, dermal fillers or facial implants alone can't lift and remove excess skin from the face and neck. Natural looking beauty is created by the aesthetic vision of what tissue layers need to be adjusted by what technique and amount.Hope this helps.