External Approach

With this approach, external incisions will be on the outside or inside of the lower eyelids for cheek implants.The approach allows for the most exact placement of the implants. If you're having cheek implants at the same time as eyelid surgery or a Midface lift, for example, your doctor will probably use the same lower eyelid incisions.

	After cheek implant.

For the chin, the external ap p ro ach uses an incision just under your chin (submental), in an existing crease. Any scarring from external incisions, once healed, is generally noticeable only to you and your doctor.

As with the intraoral approach, your surgeon will create a pocket in facial tissue under the skin and muscle. During the procedure the surgeon will carefully measure the pocket in order to select the proper size and shape of the implant.The implant can be shaped, if necessary, before it is inserted.

Plastic surgeons take great care to ensure sterility and prevent infection, and never is this more important than when incisions are in the mouth.Your physician will take numerous protective measures, which may include the following:

•  Giving you intravenous antibiotics throughout the procedure.

•  Rinsing the pocket with an antibacterial solution.

•  Not allowing the implant to come in contact with mouth fluids or skin.

•  Changing surgical gloves before placing the implant.

•  Not touching the implant at all, even with a gloved hand.

Once the implants are in place, the surgeon will close the incisions using dissolving sutures in the mouth or small, removable external sutures. If you had cheek implants, your cheeks may be lightly bandaged. After chin augmentation, the chin is generally taped to minimize swelling and discomfort and to hold the implant in place.

After Your Facial Implant Procedure

After your cheek or chin implant, you'll have some postsurgical swelling, but you will see results instantly. Your face will have fuller, more balanced, natural contours - the "good bones" you may not have been born with. You'll have a stronger, more attractive profile, and you'll feel better about the way you look. Your doctor will probably use synthetic implants that retain their structure and shape, so it's unlikely you'll ever need to have them replaced.

If the incisions are in your mouth, your surgeon will give you specific instructions for diet and oral hygiene. He or she may recommend using an antiseptic mouthwash with warm water several times a day and not using a toothbrush near the incisions.

Side Effects, Risks, and Complications

Your face will feel stiff at first, so moving your mouth - smiling, talking, eating, and laughing, for example - might be difficult and a bit uncomfortable for several days. Your doctor will probably prescribe a soft diet for the first few days.

If your incisions are in your mouth, there will be no visible scars. External incisions will leave small, thin, white scars, but your doctor will have placed these incisions where the scars will not be noticeable.

The chance of complications with implant surgery is very low - under one percent. If your surgeon has successfully performed many such procedures, your risk is even lower. Your doctor, however, will explain the risks of your particular procedure. Very rare complications include shifting, extrusion (the implant projecting out of its pocket), or malposition (incorrect placement of the implant). To prevent these complications, your surgeon will customize the implant's size to fit snugly in the pocket. Heavy scarring can sometimes push an implant out of position, but this is extremely unlikely if you are not prone to keloid or hypertrophic scarring.

Combining Implant Surgery with Other Procedures

Cheek and chin implants may be done at the same time. Each of these procedures can also be performed with facelifts, rhinoplasty, eyelid surgery, Endoscopic Forehead Lifts, and skin resurfacing.

Though cheek implants can be done along with a facelift, they might instead delay the need for a facelift. Besides restoring fullness to your cheeks, these implants sometimes lift sagging tissues and smooth the lines between your nose and mouth. In patients with a great deal of sagging in the midface, however, cheek implants might not provide enough lift and smoothness and a facelift or midface lift may be more helpful.

Questions to Ask the Surgeon?

• How long will my implant last?
  
• Can my implant be removed if necessary?
  
• Where will my incisions be?
  
• If you insert the implant through my mouth, is there a greater risk of infection?
  
• Which implant material will you use? What are its advantages and disadvantages?

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