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Cheekbone
augmentation
Malar Implants
The facial skeleton and its covering soft tissues shape the features of the face
and the profile. The relationship between the different parts of the face has
a fundamental aesthetic importance. Well-marked cheekbones give an aesthetic framing
of the eyes, often by well-made make-up.
Principle:
Bone reduction is done by abrasion or chiselling, sometimes by moving of a bony
segment. Augmentation is done either with transplants of bone or cartilage, mostly,
however, with synthetic implants.
A surgical pocket is created and during
healing, the implants will be anchored at place by the surrounding connective
tissues. Some
deformities and asymmetries of the face need extensive pre- and postsurgical treatment
by different expert teams and these will not be discussed here. The
most performed procedures are:
 | Shortening
of the chin: Through an incision in the mouth to abrade or chisel off a piece
of bone. | | Elongation
and widening of the chin: Through an incision in the mouth or below the chin,
a suitable implant is inserted. | | Augmentation
of cheekbones: Augmentation through the mouth or during an eyelidoperation. |
| Hollow
middle face: Augmentation through the mouth or the nose. |
| Narrowing
or widening of the lower face: Either augmentation or removing bone of the angle
of the lower jaw through the mouth. | In
all cases the implant is adjusted according to desirable size and shape and given
conditions. The implants are fixated with tape/bandage for 5-6 days. Anaesthetic:
Mostly local anaesthetic and conscious sedation. Operating
time: 1 - 2 hours. What
happens afterwards
| When
the anaesthetic subsides, a short intensive pain can be felt about ½ an
hour. | |
The following discomfort is lessened with painkillers. |
| A
heavy swelling of the face evolves, that will dissolve in about 7-10 days. The
breakdown can be accelerated with ice bags. |
|
Prophylactic antibiotics are prescribed. | | After
operations through the mouth, fluid food should be eaten the first 3 days. Otherwise
mashed food. | |
Sleeping on the back is mandatory during the first 2 weeks. |
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Normal social activities can be returned to after 10-14 days. |
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Complications
Referred unwanted biologic events can occur with a certain
low frequency and must be regarded as calculated risks. Other risks not mentioned
can also occur. For patients this must be considered before a decision for plastic
surgery is set.
Bleeding: All operations can cause postoperative
bleeding. These risks increase by the intake of analgesics and Vitamin E. These
should be avoided 2 weeks prior to the planned operation.
Infection:
All operations can cause infections. The mouth is from surgical point of view
heavy contaminated and in spite of prophylactic antibiotics, infection can occur.
An implant has to be removed temporarily and can be reinserted after a few months.
Displacement of an implant: A correctly placed implant is normally
kept in place by scary healing to the surroundings. Occasionally an implant can
be displaced before proper healing. In that case a reoperation is necessary. Nerveinjury:
Facial implants are placed in near proximity to nerveexits of sensory nerves.
These nerves are protected during the operation. If the implant, however, is displaced,
it can irritate or damage the actual nerve, which can cause numbness or pain in
the corresponding area. Smoking:
Smoking does compromise bloodcirculation and healing. Smoking should be abandoned
prior to a planned operation. | This
text is edited and controlled by Dr. Per Gunnar Opitz, Opitz plastikkirurgiska
klinik i Malmö Sweden | 
