Sunken-looking cheekbones appear more pronounced after padding (synonym: cheekbone padding), giving the face a more youthful appearance and attractiveness. Sunken cheekbones do not correspond to our ideal of beauty and make the face look unharmonious in profile. We perceive as more expressive and youthful a face whose cheekbones are higher and appear more pronounced.
Indications (areas of application)
- Harmonization of facial features
- Reconstruction of the cheekbones after trauma (accident).
Contraindications
- General medical findings that prohibit a surgical procedure.
- Incomplete cheekbone growth (childhood and adolescence).
Before the procedures
In an intensive informative interview, the various procedures and the associated risks are explained. A facial analysis and, if necessary, X-rays contribute to the decision for a specific procedure as well as an allergy test. This must be performed four weeks before the planned procedure for material with allergenic potential, such as collagen as a filling fluid or silicone as an implant.
The procedures
Depending on the severity of the procedure, cheek correction is performed under local anesthesia (local anesthesia) or general anesthesia.
I. Injection of collagen foreign to the body
Before the procedure.
Specially prepared, purified bovine collagen is used for injection. The manufacturing technique is intended to minimize allergic reactions. Nevertheless, allergy testing is indicated four weeks before the scheduled procedure. To build volume, the collagen is injected under local anesthesia (local anesthetic) directly over the cheekbones with a fine needle. The treatment success lasts for one to two years. After that, the procedure can be repeated at any time.
Possible complications
- Allergic reactions in the injection area
- After bovine collagen implantation, patients develop immune diseases more frequently than the average population. These are collagenoses such as dermatomyositis or polymyositis. Disease symptoms develop 1 to 24 months after injection. The course of the disease corresponds to the picture of a progressive autoimmune disease. The risk-benefit ratio of the treatment thus appears questionable.
- Necrosis (demise of tissue) – especially with poor circulation, for example, in smokers.
II. Injection of autologous fat
To circumvent reactions to tissue foreign to the body, volume augmentation can be performed with autologous fat, which is previously aspirated from other parts of the body, such as the hips or abdomen. The FAMI technique (facial autocraft muscle injection, non-invasive reconstructive autologous fat implantation technique) has proven successful in this regard. Unlike classic lipofilling, which uses sharp cannulas, the FAMI technique uses blunt cannulas with side openings that are inserted deep into the tissue. For better distribution of the filling material, the tissue at the injection site is loosened with the help of the blunt cannulas. In this way, the fat is incorporated into the tissue compound of the cells and the connective tissue is induced to form collagen fibers, which means that the treatment result remains stable over a longer period of time. Nevertheless, the duration of the treatment success cannot be predicted. The treatment can be repeated at any time. Possible complications
Autologous fat injections are usually very well tolerated. Nevertheless, complications can occur such as:
- Inflammation of the surgical area
- Redness and swelling in the injection areas.
- Sensory disturbances in the graft area
- Erysipelas (acute skin infection often accompanied by fever and chills).
III. Injection of hyaluronic acid
Injection of hyaluronic acid, a natural component of connective tissue, has been equally successful. It is both derived from animal tissue and produced synthetically (NASHA gel: non-animal stabilized hyaluronic acid), which virtually eliminates allergic reactions. The hyaluronic acid is injected under local anesthesia (local anesthesia) with fine injection cannulas into the areas to be filled. The procedure takes only a few minutes.Hyaluronic acid is gradually broken down by the body, but about 20% of the volume gained is retained by the formation of new connective tissue. The duration of the treatment success of a hyaluronic acid injection also depends on the type of hyaluronic acid used: If cross-linked molecules are used in production, the treatment success lasts up to one year. In the case of non-cross-linked hyaluronic acid, follow-up treatment may be required after just one to four months.
Potential complications
Hayluronic acid injection is considered a very well-tolerated method. Adverse late reactions are not to be expected. Nevertheless, the following complications may occur:
- Hematomas (bruises)
- Infection (inflammation)
- Redness and swelling in the injection areas.
- Hypersensitivity reactions (very rare).
- Up to months delayed onset nodule formation.
IV silicone implantation
Implants made of hard silicone for cheek augmentation are available in various shapes and sizes and are selected jointly by the surgeon and patient before the procedure. The incision (cut) required to insert the implant is made either from the inside of the cheek, on the lower eyelid, or in the temple area. The skin and muscle tissue are then dissected (separated) from the underlying bone to form a pocket that can accommodate the implant. After insertion of the silicone cushion, which is secured with sutures or fine titanium screws, the wound is closed with the finest suturing technique. This procedure allows for permanent cheek augmentation, as the material is not broken down by the body.
Possible complications
- Wound healing problems in the surgical area due to infections, these may require implant removal in some circumstances
- Scarring possibly keloid formation (bulging scars / scar proliferation with skin discoloration).
- Sensory disturbances in the area of the scars
- Implant rejection
- Slippage of the implant due to lack of fixation.
- Allergic reaction to implant material or injection fluids.
- Permanent numbness
- Hypersensitivity or allergies (e.g., anesthetics/anesthetics, medications, etc.) may temporarily cause the following: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
- Anesthesia riskAs after any surgical procedure, thrombosis may occur, with the possible consequence of embolism and thus pulmonary embolism. Thrombosis prophylaxis leads to a reduction in risk.
V. Implantation of autologous bone or cartilage.
Like autologous fat injection, implantation of autologous (body’s own) hard tissue has the advantage of excluding reactions to foreign material. First, bone or cartilage must be harvested from another part of the body. Cartilage or bone parts from the nose, ear or pelvic bones can be considered for this. The material is then prepared and shaped into the required form. The incision, preparation of the pocket for insertion of the implant and wound care are performed in the same way as for silicone implantation.
Possible complications
- Cartilage is subject to unpredictable remodeling processes after implantation if it needs to be shaped, which is the norm.
- Wound healing disorders due to infection (inflammation).
- Scarring
- Permanent numbness
- Hypersensitivity or allergies (e.g., anesthetics/anesthetics, medications, etc.) may temporarily cause the following: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
- Anesthesia risk
- As after any surgical procedure, thrombosis may occur, with the possible consequence of embolism and consequent pulmonary embolism. Thrombosis prophylaxis leads to a reduction in risk.
After the procedures
Following surgical cheek correction, the patient receives a supportive tape dressing. If the incision is made intraorally, good oral hygiene should be maintained postoperatively and supported by rinsing with CHX (chlorhexidine). Also, in the days following surgery, facial muscles should be used as little as possible and physical exertion should be avoided. One week postoperatively, the sutures are removed and follow-up or control appointments are made.
