Malar augmentation, also known as cheek enhancement, is a surgical procedure intended to highlight or emphasize the cheek bones, creating a more proportioned and balanced facial appearance. Older patients with sunken cheeks can achieve a fuller look with malar augmentation and younger patients can achieve a strong cheek-boned look. To augment (add to) the malar region, a surgeon may place a solid implant over the cheek bone or, in the appropriate patient, use injectable filler materials. In rare instances and for specific reasons, the cheek bone can be cut and repositioned.
Cheek implants are made of a variety of inert materials: high density porous polyethylene (Medpor®), ePTFE (expanded polytetrafluroethylene, trade named Gore-Tex®), and solid silicone. The former two materials tend to integrate with the surrounding tissue more than solid silicone implants. Injectable filler materials include commercially available products such as Restylane® or Juvederm® or the patient’s own fat.
There are kinds of cheek implants: malar, submalar, or combined. Malar implants are placed directly on the cheek bones, giving a higher contour to that portion of the face. Submalar implants are placed in a slightly different location and are for people who have a sunken appearance of the midface. Combined implants, in the proper candidate, augment both the midface and the cheek bones. Cheek implants are customized to fit each individual's face.
Ideal Candidates
Ideal candidates are those who want definition of the face, in particular, the malar region. Candidates should be in good physical and emotional health, not allergic to the implant material, and with realistic expectations.
The Surgery
The surgical procedure may be combined with other cosmetic surgical procedures such as facelift or a chin implant. The procedure is done as an outpatient, usually under deep sedation or general anesthesia. The procedure takes on the average about 1 – 1 ½ hours.
The surgeon will usually make an incision inside the mouth between the upper lip and gum, one incision on each side. The implant is carefully slid into position through this incision, precisely placing it in the desired position. A small titanium screw may be used to attach the implant to the bone.
When the malar region is augmented with the patient’s own fat, the procedure is usually done in the operating room. When products such as Restylane® or Juvederm® are used for augmentation, the procedure can be done in the office. The latter two products are temporary, and no longer produce correction once the body has resorbed the material. Autologous fat – fat taken from other areas of the patient’s own body and injected back into the face or other areas – can be a more permanent solution but are not necessarily used interchangeably with a surgical implant.
Recovery and results
Swelling is expected and patients may experience some bruising and/or numbness and/or a feeling of tightness in the face. Pain is usually mild to moderate and usually is readily controlled with pain medications. Patients are asked to keep the head elevated when lying down or sleeping. Cold compresses can help reduce swelling. Actions such as smiling, chewing or brushing the teeth may be difficult for a few days; patients are encouraged to modify their diet to avoid or minimize chewing. True complications are unusual, and include infection, bleeding, permanent numbness of the skin of the middle portion of the face, asymmetry, movement or displacement of the implant, or scarring.
Patients are usually able to return to work in 5 – 7 days and may begin exercising in about 2 – 4 weeks. Strenuous exercise or rough contact with the face should be avoided for 4 weeks.
Results are permanent when an implant is used and no additional surgery is needed unless, in rare cases, the implant shifts location.