1) The middle of my face looks flat. Will cheek implants help?
Most likely. Cheek implants are often used for facial wasting or complaints of a "hollow" look. Cheek implants enhance both the soft tissue and bony part of the face depending on which type of cheek implant is used and the placement.
High cheekbones are a sign of beauty. The first type of cheek implant - malar implants - augments the bony cheek. The other type - submalar implants - augments the hollow under the eyes (also known as the infraorbital area: infra (under) + orbital (eye) = infraorbital area). Care must be taken to select the proper implant characteristics for the desired cosmetic result, since each type of cheek implant has unique properties.
Of course a complete health assessment including a head, face and neck exam will need to be performed to determine the reason for the flat face. Facial analysis - examining genetics, congenital abnormalities, dietary habits, trauma, disease processes and aging (to name a few) - is an important part in determining if cheek implants are right for you. A qualified plastic surgeon will also point out characteristics unique to your face - even asymmetries that you may not have previously noticed - before surgery so that you are aware of the exact effect a cheek implant will have based on your individual bony skeleton and facial structure.
2) Will cheek implants improve the hollow look under my eyes?
Same answer as above. Flat cheekbones can make a face look dull and aged. A submalar cheek implant can augment the hollow look under the eyes resulting in more prominent cheekbones, the latter of which are perceived as a fresh, youthful appearance.
3) What are cheek implants made of?
Actually there are several types of cheek implants available. The oldest synthetic implants are silastic. These have been on the market since the 1950's and continue to be the most widely used implant in the world. Gore-Tex, which has been used for years in such surgery as heart and vascular surgery, is also a material accepted well with a minuscule rejection rate. The newer cheek implants have the ability to provide a more natural appearance.
4) Are cheek implants safe?
Yes, in the hands of a qualified facial plastic surgeon. Implantable materials have been used for centuries in reconstructive and cosmetic surgery. The complication rate is low. Infection less than 1%, rejection is less than that.
5) "If I have cheek implants will I look pulled or too tight?"
This is one of the most common questions in cosmetic surgery. Will I still look like "me" after my plastic surgery? Many of our patients report that, upon return to work and routine daily activities, friends and acquaintances make the following remarks: "Gee you look great. Did you change your hairstyle?" or "Have you been on vacation?" Retaining your uniqueness is the sign of a successful plastic surgery procedure. Although the change may be significant to you, it's not uncommon that friends and family don't really notice the specific changes unless patients request dramatic changes.
6) Will cheek implants dramatically change the appearance of my face?
Cheek implants can achieve a subtle or more dramatic effect depending on the size, selection and placement of the implant. This is where is it vital to have a good understanding with your facial plastic surgeon prior to undergoing any cosmetic surgery. Evaluating realistic expectations and motivation behind cosmetic surgery is essential. Some patients who request a dramatic change - "to look like someone else" - can potentially raise a red flag to find out more about their motivation and self esteem. On the other hand, a patient may know from the time of their own youth - from looking at parents and relatives who appeared sunken or hollow and older than their age - that cheek augmentation is right for them. In the latter case, the expectations and motivations are well thought out and very realistic.
One sign of a good board certified facial plastic surgeon is one who can tell the difference between realistic and unrealistic expectations and one who will be truthful about meeting each patient's desires. Our biggest referral source is from satisfied plastic surgery patients - ones who have had realistic expectations and were satisfied with results.
7) Will cheek implants lift the rest of my face?
Not significantly. Many patients who request cheek implants want to also address sagging or a "tired" look and have a facelift at the time of cheek augmentation. With a facelift the relaxed muscles under the skin are "tightened" and the excess skin is removed. Tightening the muscles also eliminates the "turkey wattle" (that floppy thing that hangs down on a turkey's neck) and results in a more youthful appearance.
8) How long will my cheek implants last?
Cheek implants are a structural change and as such are permanent.
9) Will a cheek implants help the dark circles and bags under my eyes?
If you have dark circles and bags under your eyes, you are most likely hoping for the benefits of a blepharoplasty (eyelid lift) which often uncovers hidden beauty of the eyes. Cheek implants may provide the structural augmentation you seek, however, it will not meet the expectations of most patients whose primary concern is the bags under or dark circles around the eyes. It is most common that patients with these two concerns, have a combination of plastic surgery procedures which may include cheek implants, blepharoplasty (eye tuck) and possibly skin resurfacing (such as a skin peel for the dark discoloration).
10) My face looks drawn and hollow. How do I tell if I need cheek implants or facelift?
If you have jowling along the jaw line and a turkey wattle neckline along with a sunken look, you are most likely considering improvements derived from a facelift and cheek implants. It is not uncommon for patients who are learning about the face to gain an appreciation for the underlying principles of beauty, including symmetry and balance. One of the benefits of complementary computer imaging is the ability for you to obtain a good idea ahead of time about the overall balance of your face, including changes in texture and tone of the skin, existing muscle tone and the presence or lack of defined structural support. Based on a thorough exam, a board certified facial plastic surgeon is expertly qualified to discuss whether you are a candidate for cheek implants, a facelift or both.
11) Will cheek implants get rid of my facial wrinkles?
Cheek implants will not affect the textural changes in your skin. As we age, our skin looses its elasticity. A facelift is most often performed to "lift" and remove sagging skin and as a result eliminate some wrinkles. Some of the deepest lines (such as the frown lines between the eyes that are improved with a Brow Lift) may not completely resolve but they will be significantly improved. Further improvement can be achieved with Skin Resurfacing such as CO2 laser. Fillers such as Fat Injections can improve wrinkles and are particularly effective on laugh lines or smile lines. Patients who are not ready for plastic surgery visit Q-the Medical Spa at Lindsay House to consider Botox, Restylane injections, microdermabrasion or several other conservative procedures - many of which can be performed on the lunch hour.
12) I had cheek implants somewhere else and I don't like my result. Can you "fix" it?
It's not uncommon for patients who have previously had cosmetic surgery to be referred to the Lindsay House for revision cheek implant surgery. Although patients may want immediate adjustments to the original cheek augmentation, patients be carefully evaluated prior to undergoing revision cheek implant surgery. For example, postoperative cheek augmentation swelling may take months to resolve. It would be unwise to perform revision surgery prior to all swelling being gone. Perhaps the resolution of swelling is all that's needed to make for a satisfied patient.
Typically, final results of cheek implants are not evaluated until one full year postoperatively. As stated previously, it takes a year for postoperative swelling to subside and healing to be complete. Changes, however subtle, continue throughout the 12-month course following facial plastic surgery. As time goes by, the face gradually looks different. Features refine as the swelling resolves. These refinements sometimes are enough for a result to be deemed acceptable.
A second consideration is scar formation. Cosmetic surgery is challenging enough without battling through scar tissue that has not matured. Scar tissue is somewhat more compliant in the hands of the plastic surgeon when it has been allowed to soften over time. Even after a year the presence of scar tissue makes revision plastic surgery more complex. Give your cheek implants every possible opportunity to "settle" and refine before undergoing another plastic surgery.
13) Why is revision cheek augmentation more difficult than first-time cheek augmentation?
Many reasons. First, after any cosmetic surgery, scar formation creates a thick, tough layer that is more difficult to work with than original tissue. Second, the original location of (anatomical) landmarks have been altered. Third, the overall skill level required to perform a successful revision plastic surgery is greater. Revision cheek implant surgery can take a little longer because of corrections that need to be made as a result of the initial surgery. It is best to provide a patient with a realistic picture of exactly what can be accomplished prior to undergoing another cheek augmentation surgery. Revision cosmetic surgery has humbled even the most experienced board certified facial plastic surgeon…and at the same time has been the most rewarding.
14) Is the cheek implant surgery painful?
Most patients who have cheek augmentation say how surprised they are at how mild the postoperative discomfort is. Patients more typically complain of tightness or fullness from swelling. Understandably, after any plastic surgery procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients sometimes use the prescription medication two to three days after surgery and then switch to Extra Strength Tylenol. It is uncommon for patients to report unmanageable pain after their cheek implant surgery.
15) Where is the incision for cheek implants?
Most cheek implants are inserted through an incision just under the upper lip. After the implants are inserted, the incision is closed with dissolvable sutures.
16) Tell me about the numbness associated with cheek implants.
Numbness, especially near the incision lines, is most noticeable in the immediate postoperative period. Many patients report resolution of numbness within about six weeks following cheek implants although patients are told to expect it to lasts up to three months
17) Will I be awake during my cheek implant surgery?
Using IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room), patients are asleep during cheek implant surgery. Patients do not hear or feel anything and are comfortable during the operation. Patients wake up very soon after the surgery is completed. Intravenous sedation is a type of anesthesia; therefore all plastic surgery patients must have a responsible adult to stay with them through the night following surgery. Patients may not drive for 24 hours after their plastic surgery procedure and this time may be longer, depending on the procedure.
18) Do I go home after plastic surgery?
Yes, most cheek augmentation surgery is done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative cheek implant appointment. Your first appointment is usually early in the morning the day after plastic surgery. We recommend that patients having cosmetic surgery stay in the immediate Rochester New York area overnight within 30 minutes of our East Avenue facility.
19) When can I go back to work or school after cheek implant surgery?
Restrictions from work are generally one week following cheek implants. Because initial cheek implant surgery swelling may still be present, patients who are very concerned about privacy take two weeks off to be safe.
20) When can I "work out?"
Aerobic activities should be avoided for three weeks following cheek implant surgery. Any activity that potentially increases blood pressure will increase the amount of time it takes for postoperative swelling to resolve.
21) How long should I stay in Rochester NY following plastic surgery?
Most out-of-town patients stay in Rochester NY about seven to ten days following cheek implant surgery. After that it's ok to fly or travel long distances.
22) I'm from out of town. Where can I stay overnight in Rochester NY?
Accommodations are comfortable and convenient for Lindsay House clients. The Strathallan, located "just down the street" provides upscale, affordable accommodations for Quatela Center for Plastic Surgery visitors. For added convenience following ambulatory surgery, some patients elect to stay in our Carriage House, located adjacent to the Lindsay House. For guests without the benefit of family or friends in the Rochester area, our staff will be happy to assist you with arrangements for a smooth, restful experience following your plastic surgery procedures.
23) I really want to do this but I'm nervous. What if I get stressed?
It's ok to be nervous. (Frankly, we would be nervous if you were taking this step lightly!) One of the best ways to deal with nervousness is to see what other patients have experienced. Take a moment to read our Patient Diary and look at Before and After Photos. Check out board certifications in Selecting a Surgeon. Remember, an educated patient knows when and if the time is right to proceed.
CHEEK IMPLANT PREOPERATIVE INSTRUCTIONS
1) What do I do to prepare for cheek implant surgery?
Although the preparation for cheek implant surgery is pretty simple, it is an essential element in a successful outcome. To prepare for cheek augmentation surgery, a preoperative appointment will be scheduled with one of our experienced nurses.
2) What happens at the preoperative cheek implant appointment?
Many things! To name a few, you will meet with our nurses who review your health history, answer your questions, instruct you on how to prepare for cheek augmentation surgery, provide prescriptions for use after surgery and tell you what to expect. Most of the instructions are listed here below. This list of questions, however, will not take the place of a preoperative visit, which is essential in determining a patient's understanding and readiness for plastic surgery. We will be sure you are signing an informed consent.
3) What does informed consent mean?
Informed consent means you have an excellent understanding about the benefits of cheek implant surgery as well as any risks, and all the preoperative and postoperative information. You are making an "informed" decision as to whether cheek implant surgery is right for you.
4) What are the benefits and risks of a cheek implants?
As part of your initial consultation, your plastic surgeon will review your expectations for your cheek implant surgery. At that time, he can provide a realistic picture of what cheek augmentation surgery can and cannot accomplish. Depending on which procedures you are interested in, we will provide you with a list of any risks reported in the medical literature associated with all procedures you are considering. Although risks from cosmetic surgery are uncommon, every patient should be fully informed of any risk associated with cheek implant surgery.
5) Where will my incisions be from cheek implant surgery?
Incisions for cheek implants are located just under the upper lip inside the oral cavity (mouth).
6) What are some of the other things to do to prepare for cheek implant surgery?
We review your health history and any daily medications you may be taking. Because tobacco abuse impedes wound healing, you will be asked to stop for two weeks before cheek implant surgery and two weeks following surgery. Our nurses will be happy to discuss over-the-counter aids to help you with this.
7) What about my daily medications before cheek implant surgery?
You will have a preoperative cheek augmentation appointment well in advance of your surgery when our experienced staff will review all mediations with you. If you are on "blood thinners," you will be asked to stop them approximately one week prior to your cheek implant surgery. We also ask that you avoid certain over-the-counter medications. We will provide a "Medication List" for medications and supplements to avoid prior to cheek implant surgery.
8) I take vitamins and supplements. Do I need to stop them before my cheek implant surgery?
Most vitamins and supplements have few side effects. However, there are some, such as vitamin E and ginkgo-biloba, that affect bleeding during your cheek implant surgery. Also, because there are now so many supplements available, we do not know how supplements interact with anesthesia. We will provide a "Medication List" for products to avoid before cheek implant surgery.
9) Do I need any special prescriptions before cheek augmentation surgery?
Most patients do not need any special prescriptions before surgery. Please let us know of any special medical concerns you may have. (We will address prescriptions needed after surgery below.) You will also be instructed not to eat or drink anything after midnight the night before cheek augmentation surgery.
10) Why will I be asked not to eat or drink anything?
Anesthesia medications can cause stomach upset. The best way to prevent after effects from anesthesia will be to avoid food or drink from midnight the night before cheek augmentation surgery. For patients with special concerns, such as a patient with diabetes, our nurses will be happy to address special arrangements with you ahead of time.
11) I'm concerned about my privacy?
During a recent independent study, confidentiality was found to be one of the advantages that attracted people most to Lindsay House. Because all consultations, office visits, surgical and nonsurgical experiences take place at the same address, the check-in process is pretty easy.
12) What happens when I check in for plastic surgery?
Our nurses will help you get ready for plastic surgery. You will have an IV and change into a gown. Please let our nurses know of any special needs you may have. Also, be assured that you have plenty of time for any last minute questions with your plastic surgeon.
13) Does someone have to stay at the Lindsay House while I have my cheek implant surgery?
No one needs to stay at the Lindsay House during your cheek implant surgery. However, you must have someone available by telephone at all times during your cheek augmentation surgery.
14) What other instructions are there?
Glad you asked! See the postoperative cheek implant instructions below.
CHEEK IMPLANT (Cheek Augmentation) POSTOPERATIVE INSTRUCTIONS
1) What do my cheeks look like after cheek implant surgery?
Following the cheek augmentation procedure, you may have a soft head wrap around your head and under your chin. This helps minimize swelling. The head wrap will be removed in the office the following morning. An elastic (ace) bandage will be gently applied to minimize swelling. You may have some bruising, however, this typically is more pronounced 24-48 hours after the cheek implant procedure.
2) What do my cheeks feel like after cheek augmentation surgery?
Most patients report only mild to moderate discomfort associated with some tightness or pulling. This pulling sensation subsides after about three weeks. We will make sure you are not nauseated or queasy. Our nurses will be right there with you as you wake up from your cheek augmentation surgery to give you special attention.
3) Will I need any special prescriptions following my cheek implant surgery?
Yes. Postoperative prescriptions are provided well in advance of surgery day so you arrive home completely prepared. Postoperative prescriptions and over-the-counter medications for cheek implant patients include the following:
A) An antibiotic (typically Keflex/cephalexin) to prevent infection.
B) Pain medication (typically Vicodin/hydrocodone) to minimize any discomfort following cheek augmentation surgery.
C) Medrol Dosepak as directed for swelling
D) Vitamin C 3000 mg. daily with food for one week following surgery.
E) As previously mentioned, over-the-counter Arnica to minimize bruising.
4) When do I start taking these prescriptions?
Patients take their pain medication as needed. The Arnica and antibiotic medications begin when you arrive home following cheek augmentation surgery. Unless you are notified otherwise, resume all daily medications when you arrive home from cheek implant surgery.
5) Are there any dietary restrictions following cheek implant surgery?
Yes. We ask you to avoid food with sharp edges such as niche chips or potato chips for about a week following cheek implant surgery. We also ask you to avoid dairy products for five days following your plastic surgery procedure. When the integrity of the oral cavity mucosa is intact, the natural bacteria found in dairy products do not cause infection. However, when there is an incision in the mucosa, we need to prevent infection by avoiding dairy products until the incision has had a chance to heal a bit. Other than the sharp edges and dairy product restriction for five days postoperatively, there are no dietary restrictions. Patients may eat whatever they like.
6) Are there any special wound care instructions for cheek implant surgery?
It's important to be very gentle with brushing the teeth the first few days following cheek augmentation so you do not disturb the sutures inside the upper lip. These sutures will gradually dissolve with time. Good oral care using an oral rinse of ¼ peroxide and ¾ mouthwash will keep the sutures clean and free of debris. There are no external skin incisions, you may have one suture on the outside skin of the cheek that secures the implant in position for the first few days while healing takes place. These two sutures are typically removed within the first 48 hours following cheek augmentation.
7) Tell me more about the sutures.
At the first preoperative cheek implant appointment the next morning following surgery, the head wrap dressing is removed. The sutures inside your mouth are dissolvable. It will be OK to gently brush your teeth. We will ask you to rinse with mouthwash after meals, snacks and at bedtime for good oral care.
8) How soon after the cheek augmentation surgery can I brush my teeth?
You can brush your teeth the next day following the cheek implant surgery. It's important to be very gentle the first few days following cheek augmentation so you do not disturb the sutures inside the upper lip. These sutures will gradually dissolve with time. Good oral care using an oral rinse of ¼ peroxide and ¾ mouthwash will keep the sutures clean and free of debris.
9) When can I shower?
You may shower or bathe at any time following the cheek augmentation procedure.
10) Tell me about my first postoperative cheek implant appointment.
You will be asked to come to the Quatela Center for Plastic Surgery the on the first day following cheek augmentation for a quick wound check. The sutures just under your upper lip inside your mouth are dissolvable and will not need to be removed. There are no external skin incisions. Typically one suture on the skin of each cheek is used to temporarily secure the implants in position. These "tacking" sutures are typically removed 24 to 48 hours following the cheek augmentation surgery. It's a good idea for someone to drive you to this appointment.
11) Are there any routine daily activity restrictions?
Sleep with head of the bed elevated or use two to three pillows for one week. Facial fullness, headache and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Absolutely no bending, lifting or straining four two weeks following cheek augmentation surgery. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap.
12) When will I look normal?
You will be presentable at one week after your cheek implant surgery. At two to three weeks postoperatively you will still notice swelling but many of your friends will not. You will look great at six weeks and even better at six months as things settle and expressions become more natural. At three weeks after your cheek implant surgery, you know you are well on the way to recovery and most patients resume routine activities around two weeks following surgery. Final results are evaluated at one year.
13) How long will bruising and swelling last after my cheek implant surgery?
Postoperative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising or swelling may take two weeks after your cheek implant surgery. However, any residual bruising camouflages fairly easily at seven to ten days with concealer stick.
14) How long does healing take?
Healing from cheek implants to evaluate the final result takes one full year. However, after three months, most patients have about 90% of their final result.
15) How can I learn more about cheek implants?
Several ways. First, contact us or call 585-244-1000 for any specific questions. If our Patient Care Coordinator can't answer them, she will gladly forward them to the appropriate plastic surgeon or staff member. We also have several patients who have had cheek implants who are willing to discuss their experience. Also, you can learn more about Selecting a Plastic Surgeon and what happens at Your Consultation appointment, or more about the training and experience of our Plastic Surgeons and Staff here on our website. We can also suggest some other resources for you to explore.