Cheek Implants Are Gaining in Popularity

The data is in and there’s a surprising finding in the world of plastic surgery: Cheek implants are among the top-five most popular procedures for those aged 31 to 45, according to the American Society of Plastic Surgeons. It’s a very permanent choice to make at such a young age (or ever), but the 30s and early 40s are around the time when people tend to notice changes in their facial structure. “It’s not so much that an average 32-year-old comes in saying their cheeks look different, but rather they see a difference in their face, which is often due to descent of the cheeks,” says Catherine Chang, MD, a board-certified plastic surgeon in Los Angeles. 

It’s a natural progression over time. “As we age, changes occur in the cheekbones and the cheek fat pads,” says Kofi Boahene, MD, a double-board certified facial plastic and reconstructive surgeon and otolaryngologist in Baltimore. “These can lead to the cheeks sagging and causing deeper smile lines.” For structural concerns like this, the average skin-care regimen can’t help — and while fillers can fill, they don’t necessarily help with lift. Even cheek-specific fillers designed to contour the cheeks, such as Voluma and Sculptra, add fullness and smooth skin more superficially, instead of sculpting and restoring dimension to the face.

“Patients say, ‘I inject and it goes away. Is there anything more permanent?’ That's when the cheek implant discussion comes up,” says Theda Kontis, MD, a double-board certified facial plastic and reconstructive surgeon and otolaryngologist in Baltimore and the president of the American Academy of Facial Plastic and Reconstructive Surgery.

Meet the experts:

• Kofi Boahene, MD, is a double board-certified facial plastic surgeon and otolaryngologist in Baltimore.
• Catherine Chang, MD, is a board-certified plastic surgeon in Los Angeles.
• Hardik Doshi, MD, is a double board-certified facial plastic surgeon and otolaryngologist in New York City.
• Theda Kontis, MD, is a double board-certified facial plastic surgeon and otolaryngologist in Baltimore and the president of the American Academy of Facial Plastic and Reconstructive Surgery.
• Jennifer Levine, MD, is a double board-certified facial plastic surgeon and otolaryngologist in New York City.

For patients interested in getting cheek implants, the goal is typically “adding volume back to the cheekbones, helping to lift the cheeks and create more definition in the face,” says Dr. Chang. Compared with other procedures that can chisel the cheekbones or restore volume, like buccal fat removal or fillers, cheek implants are more predictable — and they’re permanent, explains Dr. Kontis. The other option is fat transfer, she adds, but “the fat has to survive, and not all of it does.” (Only about 46% percent of fat transferred from one part of the body to the face will usually remain.)

Keep in mind, though, that getting cheek implants is an invasive surgical procedure with downtime — up to a week of swelling and bruising. And, again, they are meant to be permanent, so getting them is not a decision to be taken lightly. “Cosmetic surgery should always be carefully considered and discussed with a qualified and experienced surgeon,” says Hardik Doshi, MD, a double board-certified facial plastic and reconstructive surgeon and otolaryngologist in New York City. (You can confirm that a doctor is board-certified in plastic surgery at certificationmatters.org.) And now: Here’s everything you need to know about cheek implants.

• What exactly are cheek implants?
• How can cheek implants change your face?
• What’s the downtime after cheek implant surgery?
• What are the risks of cheek implants?
• What makes someone a good candidate for cheek implants — and what doesn’t?
• How much do cheek implants cost?

Cheek implants are pretty much what they sound like. “The surgery entails inserting small, solid silicone or other biocompatible material implants into the cheeks to improve the contour and projection of the cheekbones,” says Dr. Doshi. Silicone is most commonly used because it is least likely to react with surrounding tissue; but other options like polyethylene may also be used because the tissue can heal around and within the material.

All cheek implants, depending on their shape and placement, fall into one of two categories: malar or submalar, named for where the implants are inserted in relation to the malar, or cheek, bone. Malar implants are meant for more defined, pronounced upper cheekbones, “specifically intended to augment the bony prominence of the zygomatic arch, [i.e. your cheekbones],” Dr. Doshi says. “They come in a variety of shapes and sizes to accommodate the patient's specific needs and preferences,” including the shape of a curved shell or half-moon.

Submalar implants are inserted slightly lower down to add volume and contour to the area just beneath the cheekbones, or “what’s referred to as the ‘apple’ of the cheek,” says Dr. Doshi. They are shaped like ovals or teardrops and are better for fullness and lifting.

Before the procedure, your surgeon will determine whether malar or submalar works better for your face. Choosing the right implant for a patient is key, says Dr. Boahene, since “some may result in unnatural appearance.”

General anesthesia during cheek implant surgery is the norm, although some doctors will accommodate a request for local anesthesia, with or without sedation. The implant is usually inserted through the mouth: “We make an incision above the teeth and the sulcus — way up in the gum,” explains Dr. Kontis. “Then we use instruments to lift tissue off of the bone to basically make a pocket for the implant.”

Once it’s in that pocket, the implant is anchored with a screw or suture to keep it in place and minimize movement within the cheek. “If not secured into place, cheek implants can shift in the face, resulting in the implant moving to an undesired location [and even] facial deformity,” says Dr. Chang. Securing the implant seems like it should be the status quo, but, she continues, “it’s not always common because it adds cost and time to the procedure.” During consultation, ask your doctor about how they will secure the implant. After the incision has been stitched, you’re good to go because the stitches used typically dissolve on their own. Since the incision is inside the mouth, there’s no visible scar.

An alternative to inserting the cheek implant through the mouth is to place it through a small incision in the lower eyelid. The right method for you depends largely on “which way the surgeon feels most comfortable accessing the cheekbone,” Dr. Chang says. In some cases — if you’re working with a larger implant, for instance — the surgeon might want two access points. Again, this varies with each patient and the surgeon’s preference.

One reason cheek implants are so popular is that they can alter your whole face. Says Dr. Boahene, “The mid-facial bones determine how one’s eyes sit, how light reflects off the cheeks, whether one’s nose looks proportionate to the rest of the face, and also dentition [how your teeth look].”

Cheek implants also pull off what no other current procedure can achieve: “They provide more lift to the soft tissue of the mid-face, as they are firmer and can better support it,” says Dr. Chang. (Of course, a facelift also lifts, but is mostly focused on the jawline and neck.)

If you want more prominent cheekbones or are seeking facial feminization while transitioning, the structural changes offered by cheek implants can be game-changing. In fact, the latest facial gender-affirming treatments typically entail buccal fat removal and cheek augmentation because together they can better create a heart-shaped face, which is considered to be a more traditionally feminine appearance.

The one area where cheek implants fall short: They don’t do anything for your overall complexion. “While cheek implants restore volume, they do not correct wrinkles and folds from sun damage,” says Dr. Boahene.

Not only that, but there are other superficial fat pads in the face that lose volume over time, causing hollows and irregular cheek texture; since cheek implants are placed deep beneath skin, between the bones of your face and layers of tissue, they don’t always compensate for this. Essentially, they’re great for creating the look of defined cheekbones, but don’t always smooth the skin over those cheekbones to address fat loss that happens with age. In such cases, “additional filler may be indicated,” says Jennifer Levine, MD, a double board-certified facial plastic and reconstructive surgeon and otolaryngologist in New York City.

Post-op downtime after getting cheek implants is relatively short. Says Dr. Doshi, “In the days following surgery, most patients experience some swelling, bruising, and mild discomfort, which can be managed with pain medication and cold compresses.”

Swelling can last from seven to 10 days, but otherwise there aren’t a lot of visible signs that you’ve just had surgery, so you can generally go out in public and resume normal activities during this time. That said, while swelling will go down by about 50% during the first week or so, it can take six months for it to resolve entirely, says Dr. Chang. The only other real post-op limitation is exercise: You should avoid working out for three to six weeks to allow the implants to “settle” into place.

As with any surgery, when you’re dealing with an incision in the body, a bacterial infection is one of the biggest risks. “Infection may require removal of the implants,” says Dr. Boahene, adding that infection — whether severe enough to cause removal or not — is not common. (According to a study in JAMA Facial Plastic Surgery, between 2006 and 2016, only 39 instances of adverse events related to facial implants of any kind were reported to the FDA, 18 of which involved infections.)

If the implants are not anchored properly — say, a screw is skipped or the stitch to secure them pops or breaks — implants can shift. “Usually, if the implant has moved or is in the wrong position, then it would need to be removed,” says Dr. Levine.

In the hands of an inexperienced provider, there could also be the issue of a bad fit, as in, “the cheek implants are disproportionately large for someone’s face,” says Dr. Chang. In a case like this, you might even see the edges of the implants through the skin, which is a dead giveaway that the implants are too big and require removal.

Down the road, if you change your mind about your cheek implants and want to remove them, they can be taken out via removal surgery; this comes with similar risks as the original implant procedure (namely infection) and entails a few weeks of swelling.

Additionally, there is the chance that the skin around the implants may visibly change after they have been removed. A large implant could cause skin laxity over time, but “as long as the implant is not very large, the soft tissue should contract,” says Dr. Chang. That’s hard to predict, though, since it also depends on the skin’s elasticity. In this context, getting cheek implants at a younger age can be a benefit. “It typically helps minimize facial soft-tissue descent by providing more bony structural support to the mid-face,” says Dr. Chang.

Most cheek implants are made of silicone that tissue heals around, creating an enclosed pocket, or materials the tissue heals into, like a mesh. “They can get infected, they can shift, but they're not really rejected,” says Dr. Kontis. And while soft silicone breast implants carry a rupture risk and have a life span of about 10 to 20 years, these rigid implants can stay in your body forever.

Certain facial features can help determine whether cheek implants are a good idea or not. Aesthetically, someone whose cheekbones are less defined or prominent or who has an asymmetry of the cheekbones, both of which are largely genetic, makes for a potential patient, says Dr. Chang. The same is true for someone with a narrow face who wants to widen the mid-face for a more heart-shaped appearance. There’s also the appeal of longevity: Says Dr. Chang, “Someone who desires a permanent enhancement of their cheekbones, rather than using a nonpermanent filler.”

For people who already have filler, patience is key: You shouldn’t get cheek implants if you have dermal filler in your skin because this can throw off final results. “If you already have lots of filler in there, you need to [get back to] baseline to start,” Dr. Kontis says. “You don't want to put an implant in, wait for all the filler to go away, and then see what you've got.” You can either wait for your filler to dissolve on its own — which can take several months, and even then it may never totally go away — or, if you have a hyaluronic acid-based filler, dissolve it using hyaluronidase.

Most people can get cheek implants if they want them, but a possible negating factor is when someone has very little soft tissue between their cheekbones and skin. “This creates visibility of the cheek implant,” says Dr. Chang. The amount of soft tissue isn’t something the average person can figure out on their own, though; it’s usually determined by genetics and would come up during a consultation.

The average cost of cheek implants is $3,669, according to the most recent data from the American Society of Plastic Surgeons (though this can vary depending on your surgeon and location). It’s considered a cosmetic procedure by health insurance providers, even in cases of facial gender-affirmation surgery, so patients are on the hook for all costs.

Cheek implants are pricey, but they offer results that last forever and, with some exceptions, are pretty easy to anticipate. Ultimately, “what you see is what you get,” says Dr. Kontis. Especially with plastic surgery, that’s a rare thing to find. This might explain why the appeal of this procedure keeps growing — and why so many people are looking a little more lifted and chiseled these days.

More reporting on plastic surgery procedures:

• The Unlikely Rise of Forehead-Reduction Surgery
• Meet the Lip Lift, the Permanent Alternative to Lip Filler
• The Truth About Those "Temporary Nose Jobs"

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