Facial Implants

Facial Implants are used to enhance certain features of the face.

The surgery may be part of a facial feminization surgical plan, for aesthetic reasons, or for reconstruction due to a congenital problem, prior trauma, or a bony or soft tissue deficiency from an underying process.

Facial augmentation with implants typically involves placing synthetic materials deep below the subcutaneous tissue and onto the underlying bone.

Facial Implants: Cheekbone and Midfacial Implants

Cheek implants, also known as malar implants, submalar, or midface implants, create a subtle and noticeable difference in the face. Cheek augmentation creates a more youthful appearance and can be used to feminize or masculinize the midface. Cheek implants may be used alone or in combination with other procedures.

Midface implants may:

  • Create a more youthful facial appearance
  • Feminize the face
  • Masculinize the face
  • Create a more harmonious appearance to the face

Cheek implants are one way of augmenting the midface, or central third of the face. Autologous fat grafting is another method that enhances the volume of the cheeks in an aging face, for all individuals, and feminizes the face, in both transgender and cisgender women.

For individuals who desire feminization of their face, cheek implants are a reliable option. Cheek augmentation with implants is used often in transgender patients undergoing gender affirmation facial surgery. 

Cis gender females who desire a restoration of the features of their midface, or ones who desire more fullness in the cheek, may choose facial implants. Cisgender females who naturally experience a flatness in the cheek area, or who have been affected by facial aging, or another process, may benefit from malar or submalar implants.

Cis gender males experiencing changes to the midface over time or those who desire enhancement or definition of their midface may choose facial implants. Midface implants can provide a more sculpted appearance to the cheek region.

Aesthetic Considerations of the Midface

Defining features of a youthful and feminine central face, are often seen with a full, rounded, anteriorly projecting cheek appearance. These aspects of the cheek are determined by the underyling cheek bone and the overlying soft tissue, including the fat. In some individuals, the bones of the cheek may be flatter, which is known as midface deficiency. The flatness often derives from the bones and this is known as skeletal midface deficiency. In other individuals, there can be a falling, loosening, and weakening of the soft tissues that support the cheek and lower eyelid area. Other times, as for example with aging, the bone of the midface resorbs over time, affecting the lower eyelid and cheek area, particulary around the bony orbit, or eye socket.

Differences in these areas can cause a more aged versus youthful appearance. Differences related to a flatness or fullness in the cheek area can also contribute to a more masculine or feminine appearance. More angular or sculpted features at the cheek region are more commonly considered masculine.

The eyelid cheek junction is where the lower eyelid meets the cheek. The lower lid cheek junction is an important area. The cheek has an impact on the appearance of the lower eyelids. This is in part becuase the cheek provides support to the lower eyelid. The cheek provides both bony and soft tissue support. A lack of support from the cheek can result in the lower eyelid area appearing more hollow, creating shadows. When the cheek is supporting the lower eyelid region adequately, the lower lid region can tend to appear more smooth and soft.

Cheek augmentation, or a midface lift, can not only improve the appearing of the cheek region itself. It also tends to have a positive effect on the lower eyelid region.

Gender Differences in the Midface

The central cheek is generally more prominent in females than in males. That is, females tend to have more of an apple cheek type of appearance with a more anteriorly, or forward, projecting cheek. Females tend to have a rounds, and therefore, fuller cheek.

These differences at the midface can be impactful with respect to gender identification. 

Changes to the Midface with Feminizing Cheek Augmentation

When cheek implants are placed that feminize the face, these changes are made:

  • Addition of volume to the submalar, or inner cheek area
  • Lifting of the cheek due to the effect created by the implant
  • Creation of a more youthful, softer appearance to the midface
  • The lower face appears more slim
  • Enhancement of the lower eyelid area

Cheek Augmentation with Facial Implant Surgery

Midfacial augmentation typically results in the following effects:

Creation of a natural looking, youthful, balanced midface

Transformation of a flattened cheek into a rounded one

Softening of the nasolabial folds and other nearby folds and lines by expanding the soft tissue envelope

Repositioning of skin upwards, creating a midface lift

The implant acts as a spacer, or scaffold, to support the soft tissues of the midface

An expanding out of areas of hollowness in the midface

Padding of the skin of the cheek for submalar implants

Creation of a high arched cheekbone when desired

Creation of a softer, more youthful appearance of the lower eyelid region

These Terms describe Cheek Augmentation with Facial Implants:

  • Cheek Implants
  • Submalar Implants
  • Feminizing Midface Surgery
  • Midface Augmentation
  • Midface Lift

What is the Cheek Implant Like? 

The cheek implant is small and flexible. This is an occasion where a little goes a long way in that a small facial implant creates a noticeable change. Facial implants are made from various materials. Silicone is often chosen because it is flexible and can be easily modified. Dr. Costa prefers to use silicone implants in the face. The silicone implants are inert and solid.

Submalar implants lie on the malar bone and more specifically produce anterior projection, or an apple cheek appearance. This results in a more youthful and feminine appearance to the face.

Midfacial implants are versatile. There are multiple options for size, shape, and location. The implants are placed in different locations depending on the goals of each patient. Standard implants are anatomically designed. Anatomic implants are implants that are designed to reflect the natural contours of the underlying bone. Standare implants will work for many individuals. In other cases, custom facial implants may be best.

What is Cheek Implant Surgery Like? 

Midfacial augmentation is a relatively small surgery that can have a large impact on appearance, with natural looking results.

A small incision inside the mouth is made. A space, or pocket, is made for each implant. Dr. Costa typically uses small, solid silicone implants. The implant is placed in this pocket. The implant sits right on the bone and under the soft tissues of the cheek. Because of the implant location, and because of how the implant is designed, it is barely, if at all, noticeable when felt from the outside. The implant edges should not be seen from the outside. Dr. Costa uses meticulous technique to minimize bruising, incision size, and potential complications. Dr. Costa closes the incision in layers to ensure seamless healing and a secure closure over the implant. This results in a natural appearing cheek area that harmonizes well with the rest of the face. 

All sutures used are absorbable and dissolve over a few weeks time.

Midfacial or submalar augmentation can be performed with other procedures. It is often done in combination with other facial feminization procedures. Malar augmentation is also done with eyelid, nasal, or chin surgery. Another commonly performed combination of procedures is cheek augmentation and lower facelift and necklift procedures . The lower facelift lifts the lower face and neck line, and the cheek implant lifts the central face, or midface.

Example of Sub Malar Implants:

39 year old female after submalar silicone implants and lower facelift
39 year old patient before and after submalar silicone implants and lower facelift
46 year old patient who underwent placement of submalar silicone implants. Facial feminization with hairline lowering, Type 1 browbone reduction, orbital rim reduction, rhinoplasty, and tissue graft augmentation to lips were also done in combination with cheek augmentation.

Is Cheek Augmentation Scarless? 

Because the cheek implants are place through a small incision inside the mouth, the procedure is relatively scarless. There is a scar inside the mouth and this scar is not visible from the outside.

What is the Recovery Like?

Recovery is relatively simple and straighforward.

This procedure does not produce much discomfort. Over the counter pain medication and as needed, prescription medication, will keep any pain under control.

You will mainly notice swelling after the surgery, which peaks at 72 hours post operatively and then decreases. Most of the swelling will be around the cheek including the eyelids. The majority of the swelling dissipates in 2 weeks. You will sleep with your head elevated for comfort and to minimize swelling for several days. Your sutures will dissolve on their own. 

Infection can happen and it is not typical. Our office will prescribe antibiotics in the operating room and post operatively to avoid infection. You will also be instructed to use a mouth rinse three times a day and after meals to maintain hygiene at the surgical site.

There may be numbness in the cheek area that may take weeks to months to resolve. 

Will I Have Drains?

No drains are used.

When Can I Return to Work?

If this is the only procedure, you may feel ready to go back to work a week later, possibly 2 weeks later. 

Face Lift

A lower face and neck lift are often done with cheek augmentation or after facial feminization surgery. A lower face and/or neck lift treats excess skin present at the lower face and/or neck.

Cost of Cheek Augmentation 

Hairline lowering for facial feminization for transgender patients may be covered by insurance. Other times, malar or submalar augmentation is an out of pocket expense.

For cis gender patients, midfacial implants are most typically an out of pocket expense.