What is cheek augmentation?

Cheek augmentation describes a procedure or operation that is performed to add volume to the face in the cheek region. There are a few methods for augmenting the cheeks. The most common involve placing implants, fat grafting the area, or injecting an artificial filler material, such as Juvederm or Restylane.

What is the purpose of cheek augmentation?

Cheek augmentation is commonly performed either to feminize the face or to rejuvenate the aging face. Facial feminization procedures can be performed on cisgender or transgender women.

Cisgender women have been noted to have increased cheek volume and projection (forward location) in comparison to cisgender men.[1,2] This is commonly thought to be due to the effects of hormones on fat within the body.[3]

As the face ages, human tissues lose their elasticity, or stretchiness, and the ligaments and skin loosen. The fat of the face also decreases in size. This results in less volume of the facial fat, and descent, or downward movement, of the fat pads. One of the areas of the face that is commonly affected by facial aging is the cheek region.

Simulation photograph of patient prior to cheek augmentation
Simulation photograph of patient after cheek augmentation

How is cheek augmentation performed?

Cheek implants

There are multiple types of cheek implants made by multiple manufacturers. The differences are primarily based on shape and material. The implants are commonly made of solid silicone or porous polyethylene, a hard material. Placement of the implants requires an incision to be made on the inside of the upper lip. A pocket is then created immediately on top of the bone in the cheek area. The implant is placed into the pocket and is commonly secured into place using one or more screws. The incision is then closed using absorbable suture.

Common location for cheek implant placement

Fat grafting

Fat is usually harvested from the abdomen or thighs. A fluid containing local anesthetic is first injected into the site to numb the area. A small incision is created (1-3mm) and a cannula, or small tube, is introduced to pull fat from the area. The fat is then purified, which can be done through a variety of methods, prior to placement in the cheeks. After the fat has been purified, a small poke hole is placed through the skin to inject the fat. A syringe is used to inject the fat into the desired location. After injection, the puncture site is closed with suture, tape, or skin glue.

Common location for fat grafting to the cheek

Artificial filler

Since artificial filler comes pre-packaged, it can simply be injected for the procedure. The material is usually injected deep in the tissues, on top of the bones of the cheek, to produce a general increase in volume of the cheeks.

Common location for filler placement into the cheek

How much does cheek augmentation cost?

The cost of cheek augmentation has multiple variables.

Material

If cheek implants are chosen, the patient will need to pay for the implants themselves. If fat grafting is performed, there is no additional cost for the fat. It is usually taken from the lower waist but can be taken from anywhere on the body with extra fat. If artificial filler is chosen, the patient pays for the filler itself.

Operating room costs

If the procedure is being performed under general anesthesia, there is a cost for the operating room time and for the anesthesiologist. If the procedure is being performed under local anesthesia, there are no operating room or anesthesiology costs. Cheek implants or fat grafting can be performed under general anesthesia or only local anesthesia. Artificial filler is placed without general anesthesia.

Surgeon time

This has a high degree of variability and depends on the surgeon’s price schedule and the amount of time it takes the surgeon to perform the procedure.

Please contact our office to learn more about your specific scenario.

Is cheek augmentation covered by insurance for facial feminization?

This largely depends on the insurance plan enrolled in by the patient.

Please contact our office to learn more about your specific scenario.

How is the recovery from cheek augmentation?

Recovery from cheek augmentation is relatively easy but depends on the method of augmentation.

Cheek implants are placed through incisions on the inside of the upper lip. There will be pain after the procedure that is managed with oral medications. The cheeks will be sore for a few days following the procedure and it will take a few weeks for the incision on the inside of the lip to heal completely.

Fat grafting to the cheeks is performed through a few tiny incisions that are only 1-2mm in length. There will be bruising and swelling following the operation. Due to the small nature of the incisions, these will heal quickly. The swelling will last for a few weeks, and it often takes a period of multiple months to determine how much of the fat survived the procedure. Surgeons commonly quote 60% as the amount of fat that survives in comparison to the amount that was placed at the time of the operation.[4]

Artificial filler is placed through small needle pokes and results in minimal swelling that usually lasts only a few days.

How much time do I need off work for cheek augmentation?

Taking at least one week off work is ideal when cheek implants are placed or fat grafting is performed. This allows the swelling to subside and for the incisions to become less noticeable. However, depending on the extent of surgery and the desire for privacy, some people opt to take a few weeks off work to allow the incisions to heal more completely and for the swelling to subside more significantly.

It is usually not necessary to take off any time from work after injection of artificial filler.

What are the risks of cheek augmentation?

Implants

The most concerning risk for cheek implants is infection. If the implant becomes infected, it will likely need to be removed and can only be replaced once the body recovers from the infection. Since cheek implants are placed near the infraorbital nerve, there is commonly temporary numbness of the cheeks and upper lip. There is a small chance the nerve is injured during the operation and sensation may not return to its preoperative condition.

Fat grafting

The primary concern with fat grafting is that the fat does not survive and the cheeks receive incomplete or asymmetric augmentation. Fat grafting is frequently repeated and multiple sessions is sometimes the preferred approach. There is a small risk of infection, in which case antibiotics typically are necessary and sometimes drainage of the fat grafts is necessary.

Artificial filler

There is a risk of allergic reaction to filer or blockage of blood vessels leading to damage of natural tissues. Blockage of blood vessels is a rare occurrence. Infection of the filler material can occur, but is uncommon.

All

All procedures carry a risk of bleeding with them. This is usually minor and rarely a serious concern.

How long will the results last from cheek augmentation?

Cheek implants are permanent and will provide permanent augmentation.

Fat grafting to the cheeks results in immediate postoperative swelling. After the swelling subsides, the fat grafts may continue to be absorbed by the body. It will take a few months to determine how much of the fat graft survives. After that period, the fat grafts will be permanent and will change in size with natural fluctuations in weight.

Artificial filler lasts anywhere from 6-18 months and may result in small amounts of permanent changes.

The body will continue to age naturally over time, which will result in continual loss of volume of the cheeks.

Is it better to have cheek implants, fat grafting to the cheeks, or filler to the cheeks?

This is frequently based on an individual preference.

Cheek implants are best for patients who want a reliable, permanent result. However, they can be more expensive and if they become infected, they can require additional procedures. They can result in temporary loss of sensation of the cheeks and upper lip. It does leave a permanent foreign material in the body.

Fat grafting is best for patients who want a less invasive procedure that produces a permanent result and leaves no foreign material in the body. The patient accepts that multiple procedures may be necessary to produce the desired result since it is somewhat unpredictable regarding the amount of fat that survives the initial procedure.

Artificial filler is best for patients who want the least invasive procedure with the least downtime. The patient is okay with the fact that the filler material can be expensive and is not permanent. They are also okay with its impermanence, knowing it requires repeat injections over time since it is continually absorbed by the body.

Citations

  1. de Maio M (2015) Ethnic and Gender Considerations in the Use of Facial Injectables: Male Patients. Plast Reconstr Surg 136 (5 Suppl):40S-43S. doi:10.1097/PRS.0000000000001729
  2. Arnett GW, Jelic JS, Kim J, Cummings DR, Beress A, Worley CM, Jr., Chung B, Bergman R (1999) Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity. Am J Orthod Dentofacial Orthop 116 (3):239-253. doi:10.1016/s0889-5406(99)70234-9
  3. Whitehead DM, Schechter LS (2019) Cheek Augmentation Techniques. Facial Plast Surg Clin North Am 27 (2):199-206. doi:10.1016/j.fsc.2018.12.003
  4. Azoury SC, Shakir S, Bucky LP, Percec I (2021) Modern Fat Grafting Techniques to the Face and Neck. Plast Reconstr Surg 148 (4):620e-633e. doi:10.1097/PRS.0000000000008405

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