Cheek Augmentation

Overview

What is cheek augmentation?

Cheek augmentation, also known as malar augmentation, is an option for people who wish to improve the contours and fullness of the cheeks. The goal of the procedure is to add volume or lift the cheeks either through surgical or non-surgical treatment methods. There are several cheek augmentation options available:

• Synthetic implants
• Injectable fillers
• Natural tissue grafts / fat transfer

Cost of cheek augmentation procedure

The cost of cheek augmentation can vary based on multiple factors, with the most significant factor being the chosen procedure type. Typically, cheek augmentation can be accomplished through two primary approaches: surgical implants and non-surgical fillers.

The following are the average costs for different types of cheek augmentation procedures:

• Implants: Average cost can range from $3,000 to $8,000 or more. This includes the surgeon’s fee, anesthesia and facility fee.
• Fillers: The cost can vary depending on the specific product and the amount used. Here are some average costs for dermal fillers:
  • Calcium hydroxylapatite (e.g., Radiesse): $600-$800 per syringe
  • Hyaluronic acid (e.g., Juvederm, Restylane, Belotero): $500-700 per syringe
  • Polylactic acid (e.g., Sculptra): $850 per syringe / $,500 per treatment session
  • Polymethyl-methacrylate microspheres (e.g., Bellafill): $1,000-$1,500 per syringe
• Autologous fat transfer: On average, the total cost of cheek fat grafting, including both the liposuction and fat transfer is between $3,000 to $7,500.

It’s important to note that these are general cost ranges and may vary significantly depending on individual factors and the specific circumstances of the procedure.

If your interested in cheek augmentation, set up a consultation with a board-certified plastic surgeon near you. The surgeon can assess your specific needs and provide you with a cost estimate based on your individual needs.

What causes cheeks to sag or lose volume?

There are various processes that cause the unkind effects of aging on our facial skin. Among the most conspicuous of these aging processes is known as facial lipoatrophy. This is where the fat below the skin wastes away, reducing the volume of the cheeks and flattening the contours of the face. Eventually this may even lead to a sunken appearance in the mid-face. It’s a normal but particularly unforgiving part of aging. As the cheeks lose their supporting fat tissue, the skin sags and becomes dry, wrinkled, and lined.

Facial lipoatrophy is why facelift surgery (removing excess skin) often produces unsatisfactory results; it doesn’t correct the volume loss in the cheeks. Even without experiencing face lipoatrophy, some people are just not satisfied with the shape and contours of their cheeks.

The ampleness of mid-facial volume is one of the main factors that makes people look young, so many individuals wish they had fuller, more defined cheeks to compliment their face.

Are you a good candidate?

Very few people are excluded from getting filler injections. However, there are a few contraindications to the procedure: ⁽¹⁾

• Allergy or sensitivity to the filler or local anesthetic
• Active infection
• Previous serious adverse reaction to filler injection (such as glabellar necrosis)
• Being pregnant or nursing
• Having a bleeding disorder or taking medications that cause bleeding

In general, for surgical cheek augmentation, patients must be in good overall health and at a stable weight in order to be considered. If there are pre-existing dental or sinus issues, they may need to be treated before surgery is possible.

Good surgical candidates have realistic expectations (best discussed with the surgeon), deficient cheekbones with “weak” cheek structure, a narrow/flat face, or have lost cheek contour or volume due to ageing or disease.

Surgical vs. non-surgical options

Options for cheek augmentation include both surgical and non-surgical techniques.

Surgical techniques involve placing implants in the cheeks that provide volume and support. The implants may be either fat taken from your own body (“autologous fat transfer”) or synthetic (“alloplastic”). Cheek augmentation surgery procedures usually take 30 minutes to 2 hours to complete. Most surgeons use a local anesthetic, but some prefer a general anesthetic.

Non-surgical cheek augmentation involves injecting some kind of synthetic “filler” agent into the cheek, below the skin. Filler injections are much less invasive and cheaper than implants, and they often take less than an hour, involving minimal downtime. However, their main disadvantage is that their effects are temporary.  Often a combination approach is chosen; for example, many surgeons will advise injectable fillers in addition to surgery.

Treatment options

Let’s take a closer look at three treatment options for cheek augmentation:

Autologous fat transfer: in this augmentation technique, fat is “harvested” from the patient’s own body, most commonly the abdomen, but sometimes from the thigh or flank. The harvested fat is then treated to prepare it for implantation into the cheek, and then it is injected through a tiny hole (usually 1-3 mm) using a tube (a cannula). The main drawbacks of the fat transfer option are:

• The donor site requires care and healing.
• In some people there may be limited fat available to harvest.
• The surgeon cannot mold the fat very much.
• The body will reabsorb some of the transplanted fat, and it is difficult to predict how much will disappear.
• More than one fat transfer is sometimes required.

Synthetic (alloplastic) implants: synthetic implants are made from a wide variety of materials.  Among the most commonly used are Gore-Tex and Softfoam, but they are also made from silicone, metals (such as titanium), and a variety of polymers. The surgeon makes incisions usually located either in the lower eyelid or inside the mouth to avoid any exterior scars.

Injectable fillers: this non-surgical approach to cheek augmentation involves placing volume-enhancing gels under the skin to provide volume and contour to the cheeks. The fillers work in several ways:

• The gel itself provides volume.
• The fillers induce the body to produce its own volume replacement by stimulating collagen production and drawing in water.
• They improve skin elasticity and appearance by providing lasting hydration.

There are several types of injectable fillers in use:

• Hyaluronic acid (HA) – this is a synthetic version of a natural compound found throughout the body. Although HA fillers are usually used to treat facial lines and wrinkles, they are also used off-label (without FDA approval) for restoring volume to the cheeks. However, cheek augmentation requires quite a bit more product, making the procedure more costly. Their effect usually lasts 6-12 months depending on the product. Brand names include Juvederm, Restylane and Belotero.
• Calcium hydroxyapatite (CaHA) – this is a synthetic form of a compound found naturally in our bones and teeth. The only available CaHA filler is marketed under the brand name Radiesse. The volumizing effect is immediate, and lasts up to 18 months due to stimulation of continued collagen production
• Poly-L-lactic acid (PLLA) – this filler is marketed under the brand name Sculptra, and is FDA-approved to treat facial lipoatrophy. Rather than push up the skin with its own volume, it stimulates natural collagen production to fill in the space under the skin. This takes time, so it may take a few months to see the full effect. Up to three treatments a month apart may be required to get the desired effect. Its main advantage is that the effect lasts up to two years, much longer than other fillers.

Safety information

Of the three options, filler injections are the safest and easiest; however, there are potential side effects. Some of these include:

• Redness,
• Swelling
• Bruising
• Allergic reaction to the filler

Cheek augmentation surgery – as with any surgical procedure – has potential risks involved. Your surgeon will review the risks with you thoroughly to make sure that you are fully aware of the risks involved. Some of these include:

• Unsatisfactory implant selection and/or placement
• Altered lip function affecting the smile
• Migration of the implants
• Injury to a facial nerve
• Asymmetry
• Fluid collection under the skin (seroma)

Be sure to discuss all the potential risks and side effects with your healthcare provider before moving forward with any procedure.

Recovery time

Recovery type varies greatly depending on the type of treatment. Surgical options typically involve longer recovery periods then non-surgical.

Cheek augmentation surgery: You can expect your smile and speech to be abnormal for 1-2 weeks. Swelling should be expected, and ice packs and steroid medications are routinely used to address this.

Sometimes internal bleeding can occur, in which case it must be drained by the surgeon. Minor bleeding or bruising will heal on its own. No dressings are usually used, and your surgeon may give you a prescription for painkillers, antibiotics, and steroids.

You will likely be asked to avoid talking or moving your mouth too much, and follow a liquid diet for the first 48 hours.

After surgery, most patients take about a week away from work and other obligations to recover. You may find it uncomfortable to chew, smile, or yawn until your cheeks have healed.

It is important to keep your head and neck elevated at all times for the first few days to keep the implant from shifting out of place and to reduce swelling.

Filler injections: This type of treatment option is usually much easier than surgery. For many people, filler injections are a lunchtime procedure, and they return to work immediately afterwards.

Autologous fat transfer: Cheek injections are more involved than other filler injection procedures, but less invasive then surgery so it may be best to plan to rest at least one day after receiving injections.

Are you ready to take the next step? Contact a plastic surgeon or facial plastic surgeon near you to learn more.

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