High cheekbones are generally considered a sign of beauty, giving the appearance of elegance, youth and vitality. Although we have been utilizing the technique of cheekbone augmentation for many years in reconstructive surgery, it has only been within the past 20 to 25 years that cosmetic surgeons have recognized that this procedure can be used to transform a relatively flat mid face into a much more attractive appearance. It is now one of the more popular operations at our Center. While most patients electing cheekbone augmentation are women, quite a few men have also chosen this surgery to improve flatness in the mid facial region.
While cheekbone surgery is often indicated as a solitary procedure, it is usually combined with other facial cosmetic operations to enhance the overall effect of surgery. We have carried out cheekbone augmentation with facelift, blepharoplasty and rhinoplasty to mention only some of the procedures that can be merged. For this reason, cheekbone elevation may be offered to patients who are seen in consultation for other specific requests*. Cheekbone implants are made of a soft solid silicone, a relatively inert material that has been found safe for implantation following many years of experience with grafts used throughout the body. Recent intensive study has only served to confirm the general safety of these devices. The implants come in a variety of sizes, so that the proper one can be selected for each individual. The implants are carefully designed to fit the skeletal form resulting in a very natural appearance. In most cases, they cannot be felt on the surface.
The operation consists of insertion of the selected implant through a small incision made inside the mouth. The opening is made above the teeth in the fold where the upper lip meets the gum. This results in an incision that heals with no external scarring or prolonged discomfort. A small tunnel is created beneath the tissues of the cheek and the implant is inserted immediately over the natural cheekbone. The incision is closed with absorbable suture avoiding the need for later removal. Occasionally, a small titanium screw is used to attach the implant to the bone, although usually it will stay in proper position without any fixation.
There may be moderate swelling and discomfort associated with the procedure but it usually lasts only a few days. The surgery is quite safe but like all operations can occasionally be associated with complications. Patients with very thin skin may find the edges of the implant visible. It is also possible that the implant may move before final healing, but this is rare, and even when it occurs, the implant can be repositioned with good results. Infection can occur, but is also infrequent and usually responds to antibiotics.
Cheekbone augmentation is a gratifying procedure that has gained in popularity. The operation is relatively simple and safe and justly deserves its growing demand. When combined with other facial surgery, it can make the difference between a satisfactory overall result and one that is striking. We highly recommend its consideration by patients considering beautification of the mid-face.
The extended subperiosteal coronal lift, discussed previously in this book, also leads to enhancement and an elevated appearance of the cheekbones. It does so by lifting the muscles and tissues over the cheekbone. Patients, who, in the past, would undergo synthetic cheekbone augmentation, may achieve the same result without an implant when they undergo this newer form of upper facial rejuvenation. On the other hand, it is still not uncommon to insert small cheekbone implants in conjunction with this operation to further enhance the cheek area.
* We have reported our technique and experience with this operation in articles appearing in The American Journal of Cosmetic Surgery. Copies of these articles are available from our Center upon request.