Facial Augmentation: Creating Volume and Angles

What most "beautiful" faces have in common is great bone structure or, at least, pleasing facial contours -- especially when there is symmetry of the facial features. These contours naturally highlight focal points of the face such as the eyebrow arch, cheekbones, jaw line and chin. When nature doesn't satisfy, cosmetic plastic surgery often can achieve wonders using a variety of techniques and materials such as facial implants or a person's own fat. The choice of technique depends on a variety of individual patient factors, as well as surgeon preference, according to the American Society for Aesthetic Plastic Surgery (ASAPS).

Chin augmentations and cheek implant procedures can be performed on patients of almost any age, although nearly 50 percent of cheek implant procedures are performed on patients between 35 and 50.

Cheek Implants: In a younger patient, cheek implants may be used to create a more angular facial appearance. An alloplastic (not from self) implant, usually made of silicone, may provide dramatic contour changes. The results are permanent and reasonably predictable. In the older patient, cheek implants restore the loss of facial volume that often occurs with aging and, to some extent, help tighten lax skin in the mid-face. Cheek implants may be placed at the same time as other aesthetic procedures are performed, sometimes using the same incisions. Otherwise, the implants usually are placed through incisions made inside the mouth or through the lower eyelid.

Surgeons who use cheek implants feel they offer a valuable option to carefully selected patients, although surgical revisions may be necessary. Surgeons who prefer not to use cheek implants often may recommend other treatments - for example, fat grafting or, in older patients, a facelift or mid-face lift. Lifting operations will reposition the existing cheek fat pad to help restore a more youthful facial contour and, if desired, can be combined with cheek implants or fat injection to further enhance volume.

Fat Grafting: Some plastic surgeons and their patients favor fat grafting exclusively. This procedure is done using the patient's own fat removed from another area of the body, such as the abdomen.

"Some surgeons have reported excellent longevity for the results of fat injections into the cheek area," says ASAPS President Franklin L. DiSpaltro, MD. "For reasons that are not well understood, fat may tend to last longer in this area than when injected into, for example, the lips or the nasolabial folds. This might be because there is less dynamic movement of the cheeks compared to these other facial areas. However, patients should be aware that fat injections may need to be repeated to maintain optimal results."

Chin Augmentation: Chin augmentation is a well-accepted procedure performed by most plastic surgeons. It may often be done in conjunction with nose reshaping to better balance the profile. It also can be combined with a facelift or lipoplasty (liposuction) of the neck to reduce a double chin, create the illusion of a longer neck and enhance the jaw line.

There are two basic methods of performing chin augmentation. One technique, performed through an incision inside the mouth, advances the chin by moving forward the lower section of bone and wiring it into place. A more common method uses a small implant inserted through the mouth or underneath the chin. Which technique is selected depends on individual patient factors and the plastic surgeon's evaluation.

Recovery from Facial Augmentation: After any type of alloplastic facial augmentation, patients usually are out of bed the same day, but with restricted activities. Return to work should be possible within a week or two.

"Facial augmentation can achieve subtle or dramatic results, depending on what a particular patient wants," says Dr. DiSpaltro. "It is important for the surgeon to have a very clear understanding of the patient's goals in order to select the most appropriate technique and materials in each case."

Reprinted with permission from the American Society of Plastic Surgeons Web site.

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