If you look at the facial structure of a child or teenager, the lower half of their faces form a triangular shape, referred to by dermatologists as the “triangle of youth”—where the cheekbones form the base, and the chin is the sharpest point. As we age, however, our cheeks lose fat and sag, and jowls appear. This effect essentially turns the inverted triangle shape on its head, and the lower half of our faces begin to look less triangular and more like a wilting square or a rectangle.
While we used to believe that gravity was to blame for drooping skin, today’s studies confirm the importance of deep and superficial pads under the skin that store fat, and how the loss of fat in these compartments contributes to sagging cheeks and jowls. This breakthrough has revolutionized our understanding of midfacial aging and allowed for several important cosmetic procedures to gain traction in our battle to stay looking younger for longer,
If you’re interested in having cheek augmentation done to enhance your appearance, know that the results can be quite effective under the right conditions, and with a professional, board-certified plastic surgeon performing the procedure. Keep reading to learn more about the options you may have for a cheek augmentation treatment, and how these innovative rejuvenation techniques can work to make you look younger and more attractive than ever.
Movie stars Winona Ryder, Nicole Kidman, and Halle Berry is some of the world’s most recognizable faces, with long careers as award-winning actresses that span over decades. It can also be said that these beautiful women are just as famous for their eternally-youthful faces as they are for their renowned acting talent, and their distinctive bone structures and plump, cherubic cheeks have quite a lot to do with it.
As we age, our cheeks and the soft tissues and bones that lay underneath them can lose volume and start to sag downward. This “wilting” effect is widely considered to be one of the most dramatic signs of aging and can be more influential in how young or old we look than we previously thought.
Scientists have discovered that when it comes to our cheeks, beauty isn’t skin deep. While gravity does tend to pull the skin downward, when it comes to early signs of aging, two factors are much more influential to the process than the skin itself.
The first factor is the loss of the soft tissue located in pockets underneath the skin. As these fatty compartments break down over time, the loss of the tissue in these areas contributes to the sunken-in, collapsed-look that we get as we age. The second factor is a result of naturally low cheekbones, which can make a young person look older than they are. Cheek augmentation surgeries are designed to address these issues in one of three ways: with a transfer of fat cells, fillers like Juvederm® and Restylane® restore soft tissue to the cheeks, or by adding volume with a cheek implant.
If you’re interested in a simple procedure that can dramatically reshape the lines of your face for a more youthful appearance, cheek augmentation surgeries are worth looking into. In this article, you will learn everything you need to know about the different techniques, benefits, and downsides of cheek augmentation, to help you decide whether the process is right for your beauty goals.
Who is a Good Candidate for Cheek Augmentation Surgery?
The ideal candidate for all types of cheek augmentation procedures has poorly defined, hollow or sagging cheeks, as a result of the loss of cheek tissue due to genetics. It is also an option for patients with loss of tissue in the cheekbone area due to trauma or congenital deformities. In general, cheek augmentation procedures can offer very favorable results for individuals that are unsatisfied with their facial contour and would benefit from fuller cheeks and cheekbones.
For all procedures, patients taking blood thinners or anti-inflammatory medications should be sure to speak with their doctor for advice. In many cases, these medications can cause complications during cheek augmentation procedures, and patients will be advised to cease taking them before and after the procedure is completed.
Beyond these points, good candidates for each procedure are as follows:
Fat Transfers: For fat transfers, the ideal candidate has a good supply of fat cells that can be easily and safely harvested for the transfer. Additionally, good candidates are not too thin and do not have coagulation or lipid metabolism disorders, severe chronic disease states, or acute infections.
Dermal Fillers: Good candidates for cheek augmentation with dermal fillers are those seeking the same goals as they might achieve with a fat transfer but prefer the idea of a less-invasive treatment. These candidates will also be aware of the possibility of shorter-lasting results than with other options. This procedure is not recommended for patients who are pregnant, breastfeeding, or have sinus infections.
Implants: The best candidates for cheek implant procedures are those seeking a permanent solution to enhance their mid-facial area. They’ll also have healthy skin that’s not too thin, for the implants to look more natural.
What are the Benefits of Cheek Augmentation Procedures?
As different in technique as these procedures may be, each of them seeks to accomplish the same goal: to add volume and contour to cheeks that are poorly defined. Individuals with weak cheek structure, a narrow or flat face, or who have lost cheek contour due to the effects of age can benefit from the aesthetic enhancement that cheek augmentation can provide.
In soft tissue transfer for augmentation, the fat is grafted for cheek augmentation to remedy narrow cheeks or cheekbones. The process is sometimes performed as a secondary procedure after full liposuction, or as a primary procedure with small liposuction done before cheek injections. Because the injection is filled with the patient’s fatty tissue, the result is thought to look more natural and comes with less of a risk of an allergic reaction or complications. While the results are not permanent, they’re likely to last much longer than one might expect from dermal filler treatment.
While not permanent and the shortest lasting, dermal fillers are still a very effective treatment used to plump up wrinkles, deep lines around the eyes and mouth, and also the cheek areas in an augmentation treatment. In cheek augmentation, dermal fillers like Restylane® and Radiesse® are injected into the mid-facial area through very small injections just under the line of the cheekbones, to add volume to the skin and inflate sunken areas of the cheeks. This process is quick and easy, though the careful precision and expertise of your doctor are vital to the success of the outcome.
Cheek augmentation with implant surgery can expect to gain significant volume and definition to sunken or hollow cheeks. This surgery is ideal for patients that have lost soft tissue in their mid-facial area due to age, as well as those with naturally narrow cheek structures or congenital deformities. It can also help patients that have suffered injuries to their mid-facial area to regain a more natural look after trauma. One of the primary benefits of this type of treatment is that unlike the other two options, the implants are permanent and results will last a lifetime.
Are Cheek Augmentations Painful?
Pain for cheek augmentation with fillers or by fat transfer methods is easily managed with topical anesthetic creams and local nerve-blocking methods used for their administration. After the patient has been numbed for the injections, fillers are placed via small syringes and spread evenly across the skin surface. Your provider will take care to place the injections strategically while minimizing the number of injection sites as much as possible. Depending on the type of filler used, recipients of this augmentation technique can expect some amount of swelling and pain post-operationally; ice packs and compression can aid in recovery from this procedure by decreasing the swelling that occurs.
Patients undergoing cheek augmentation with a fat transfer will require not only healing from the facial injections but the liposuction procedure as well. Liposuction pain can be more noticeable than the mild pain from facial injections, and the level of pain will depend on the size of the zone where fat was grafted. In cases where the liposuction is the primary procedure and cheek augmentation is secondary, recovery pain is subsequently more intense.
Cheek implants are surgical procedures that require local or general anesthesia, and the process tends to be more invasive than fillers or fat transfers. As a result, the pain felt after cheek implants can be more intense than with other procedures, however, in most cases patients report minimal pain associated with recovery. For swelling and redness around the cheeks and under the eye areas, patients are instructed to use ice packs and pain medication approved by the cosmetic surgeon.
Preparation for Cheek Augmentation
The process you’ll follow to prepare for a cheek augmentation procedure will depend on the type of procedure you’re having. Your doctor will let you know what steps you can take to be ready for the day of your procedure, which will probably include the following recommendations:
Fat Transfer: To prepare for cheek augmentation via fat transfer, you should stop smoking at least four weeks before surgery, and continue with your smoking cessation plan for at least four weeks afterward. Patients will also be advised to avoid any anti-inflammatory drugs or those containing aspirin for two weeks beforehand, and to refrain from drinking alcohol or taking ephedrines or asthma medications at least two days before surgery. Do not take thyroid medications on the day of your surgery, and refrain from consuming caffeinated products starting the night before your procedure. To facilitate a successful procedure and recovery, your doctor may also prescribe daily supplements of Arnica and Vitamin C for as long as 14 days before and after surgery.
Fillers: Before cheek augmentation with fillers, patients are advised to avoid blood-thinning medications and anti-inflammatory drugs for two weeks pre-procedure. This includes avoiding popular over-the-counter pain relief medicines, vitamin supplements, and other products including Aspirin®, Vitamin E, ginkgo biloba, ginseng, St. John’s Wort, omega 3/fish oil supplements, Ibuprofen, Motrin®, Advil®, Aleve®, and other NSAIDs. Alcohol is to be avoided for at least 24 hours before the procedure, and the appointment should be canceled if acne or cold sore breakouts or rashes develop on the area to be treated. Patients will also be advised to eat a healthy meal and drink plenty of water before arriving at their appointment to avoid feeling nauseous or light-headed during the procedure.
Implants: To prepare for cheek augmentation with implants, stop smoking four weeks before surgery to decrease any facial scarring that can be worsened due to the effects of tobacco smoking. Also, for two weeks before the procedure, avoid all aspirin, anti-inflammatory, and herbal medications. In addition to avoiding medication that causes blood-thinning, alcohol should be avoided for two days, while eating and drinking should not take place for six hours before surgery.
How Much Does Cheek Augmentation Cost?
In general, patients should know that cheek augmentation procedures, like many other cosmetic procedures, have a wide variation in cost. The price you can expect to pay for each procedure will depend on the rates of the cosmetic surgeon you choose, the geographical location where you’re having the procedure done, and other factors that are particular to your situation.
Most importantly, the costs of cheek augmentation will vary according to the type of treatment you choose. While the least expensive procedure may seem like the best deal, the drawbacks may not make the treatment worthwhile in the long-run, which is why it’s very important to weigh the pros and cons of each surgery to evaluate those costs concerning the benefits.
For example, the cost of cheek augmentation with fillers may cost far less than the other two procedures. However, the results are temporary and will need to be repeated at least once every six months to two years, depending on the filler used.
In general, patients can expect to pay between $5,000 and $10,000 per cheek augmentation via fat transfer session. The higher cost of fat transfers is due to the multiple-step nature of the process, where liposuction, fat grafting, and fat injection procedures are performed. The cost will also depend on the amount of fat being transferred and any complications or other factors related to the pre-procedure liposuction process. It should also be noted that the results after a fat transfer are long-lasting but not permanent, and patients will need additional maintenance treatments every year to five years after the initial procedure.
The cheek implant procedure can cost between $2,400 to $5,000 for a one-time-only surgery and could depend on several factors including the type of anesthesia used, the incision technique chosen, and the material of the implant. These prices can vary depending on your surgery center, and you should talk with a representative to learn more.
Are There any Side Effects or Complications after Cheek Augmentation Procedures?
The recovery process after a fat transfer will include soreness, bruising, redness, swelling around the eyes and cheek areas. These side effects are minimal, and most will subside after two weeks after the transfer. Before the procedure, your doctor will explain the risks and potential complications that could affect the process, including a possible but unlikely risk of infection, prolonged edema, asymmetry, and fat necrosis, as well as unpredictable re-absorption that may cause the patient to need additional transfers after only six months.
In general, fillers can cause minimal and temporary redness, bruising, and swelling. In rare cases, however, the side effects of fillers can be serious—with complications that include erythema, necrosis of the skin, infection, and in some reported cases, dysesthesia and infraorbital nerve injury that can cause numbness. Other reported symptoms after using dermal fillers include occasional nodules, lumps, visible material, and malar edema.
When recovering after cheek implant procedures, patients may have numbness or bleeding around the treated areas and the site of the incisions, and difficulty talking and smiling for some weeks after surgery. The most reported side effects and complications after this procedure are a heightened risk of blood clotting, and infection. If the infection of the implant should occur, or if the implant should move out of place at some point after surgery, a second procedure may be scheduled to deal with the infected implant or to correct its placement.
What Types of Cheek Augmentation Procedures Are There?
The three most common techniques utilized in cosmetic surgery for cheek augmentation are fat transfers, dermal fillers, and implant procedures. While all three share the same common goal: to add volume and contour to cheeks that lack definition, they vary in technique and several other important factors. In general, all procedures cater to individuals with weak cheek structure, a narrow or flat face, or who have lost cheek contour due to the effects of age and can benefit from the aesthetic enhancement that cheek augmentation can provide.
The first technique, cheek augmentation with implants, is a surgical procedure and the only cheek augmentation technique that is permanent. Cheek implants come in a wide variety of different materials. However, the most frequently used are solid silicone implants, Gore-Tex implants, which are made from expanded polytetrafluoroethylene, and Medpor implants. Medpor implants, made from porous polyethylene, fuse to the bone over time. While this option can look more natural and possibly cause less risk to the patient in the long-term than other implant materials, the fact that the material fuses to the bone can become problematic should the patient want to remove the implant in the future.
For cheek augmentation with a fat transfer, unwanted fat cells are removed from the abdominal, thigh or hip areas to be grafted into facial areas deficient in volume. The fat cells are carefully distributed where needed, sculpting the face with a fuller, healthier, and more youthful look.
The final option for cheek augmentation uses injectable fillers such as Restylane®, Radiesse®, and Sculptra® (hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid), which are used to create temporary fullness in the facial areas. The fillers are administered with a syringe, and as a result, do not require incisions or sutures. This technique is associated with a shorter recovery period, although the results for this procedure may not last as long as the other options.
What are Cheek Augmentation Procedures Like?
The three techniques used for cheek augmentations are very different from each other, and it’s important to schedule a consultation to speak to a facial plastic surgeon about the one that’s best for your individual needs. Your reasons for wanting the procedure, your skin type, facial structure, and expectations will all play an important part in determining which one is the most suitable for you.
The simplest procedure on the list is cheek augmentation using dermal fillers. To begin, your doctor may use a topical anesthetic cream (EMLA) or local anesthetic nerve block to keep the patient comfortable and pain-free during the procedure. Once the patient is comfortable, and anesthesia has been properly administered, the doctor will carefully begin injecting tiny deposits of filler at strategic points along the buccal region—focusing on a smooth application of filler between the lower eyelid, nasolabial fold, and the cheek. Your doctor will also take care to limit the number of puncture sites as much as possible while aiming for a smooth and even application process.
Fat transfer injections are very much like filler treatments for cheek augmentation, in that both procedures utilize injections of substances designed to add volume to the cheeks. In a fat transfer procedure, however, the substance used isn’t an artificial substance. Instead, the material is natural fat from the patient’s body, usually from the legs, thighs, or stomach areas. While dermal filler treatments begin as soon as anesthesia has been administered, for fat transfer procedures, your doctor will need to perform a quick liposuction procedure before performing the actual cheek augmentation. Once fat cells have been properly removed, cleaned, separated from other cellular debris, and purified in preparation for injection, the fat will be injected into the cheeks using specialized syringes. Interestingly, this process is the reverse of what one might expect with a buccal fat removal procedure, which takes fat cells out of the cheeks to sculpt and redefine more prominent cheeks.
In cheek augmentations with implants, your doctor will discuss cheek implant materials with you. Typically, patients choose either solid silicone (the most popular option), Gore-Tex®, or Medpor implants, a decision that will depend on your preferences and your doctor’s recommendations. Your doctor will also help you decide where to make the incision location, either beneath the eyelid or inside the mouth.
To begin the surgery, your doctor will carefully draw lines along your cheeks to determine proper placement for the implants. You’ll then be sedated with either local or general anesthesia, or a combination of the two, and surgery will begin with the incision technique agreed upon before the start of the surgery. Through this incision, the doctor will slip the implant into a pocket of facial tissue, which will hold the implant in place in two areas: the outer upper cheek (malar implants) and the lower or mid-cheek areas (submalar implants). Once the implants are in place, your surgeon will close the incision with sutures and cover the area with compression bandages.
What is the Recovery Process Like After Cheek Augmentation Procedures?
In fat transfers, post-operative clients can expect a full recovery in five to ten days. This general time-frame for the elimination of swelling and bruising varies slightly from patient-to-patient. Patients can expect to return to work and to resume most of their normal, daily activities after 48 hours, assuming that the activities are not physically strenuous.
After filler treatments, patients can expect to make a full recovery in most cases between seven to ten days after the procedure, though the length of time will depend on the type of filler used and the skin type and other factors related to the individual patient. While this timeframe is only slightly longer than recovery times for fat transfer procedures, the recovery process may be much easier with less noticeable symptoms like swelling or bruising, and possibly, less defined results.
Recovery after cheek implants requires a longer downtime than with the previous procedures. Symptoms that appear within the first 72 hours after surgery are the most pronounced, though side effects should lessen considerably after these initial three days. After two weeks, all facial swelling should subside, although any lasting redness could take up to several weeks to completely disappear. The patient should avoid sleeping face-down for at least six to eight weeks after surgery to avoid inflicting trauma on the implants and sutured areas.
The Pros and Cons of Cheek Augmentation
For most patients, natural-looking results are the primary goal of any cosmetic operation, whether its cheek augmentation or a tummy tuck, breast augmentation, eyelid surgery, brow lifts, or another type of enhancement. In the case of cheek augmentation, all three techniques can provide excellent and very natural-looking results, and choosing the right procedure requires research, consultation with an experienced cosmetic surgeon, and a careful consideration of the pros and cons of each method.
Augmentation via fillers is less-expensive per treatment, minimally-invasive, and the recovery process is fast and easy. On the downside, the results may last just six months in some cases, and most patients will need yearly treatments to maintain their results. Fat transfer procedures with fat grafting offer longer-lasting results than you’ll typically see with fillers, with some patients lasting for five years between maintenance treatments, and many cosmetic surgeons agree that this method produces the most natural-looking results. Still, the downsides to cheek augmentation with fat transfer procedures can often outweigh the benefits, which can include the high cost of the procedure, and the possibility of needing maintenance treatments more frequently—sometimes after only one year.
Cheek implants can be a more affordable procedure than fat transfers and generally offer permanent, lasting results. Since this procedure is surgical, the patient will have sutures to care for, a longer recovery period, and a slower return to normal, everyday functioning. Aside from the potential side-effects that are particular to implant procedures, like infection or the movement of the implant, many of the drawbacks are similar to filler and transfers, like bruising and redness after surgery.
If you are interested in having your cheeks augmented with a fat transfer, filler, or implant procedure, contact a board-certified cosmetic surgeon’s office to schedule a consultation with a reputable doctor. Your doctor will evaluate your facial structure, your medical history, and your aesthetic goals, to determine the best procedure that addresses your individual needs as a patient. For assistance in finding the best cosmetic surgeons in your area, consult the database at the American Society of Plastic Surgeons for medical professionals in the United States, or internationally at the International Association of Plastic Surgeons.