Cheek augmentation is a cosmetic surgery done to enhance a deficient cheek area to balance the facial features by augmenting the cheek using

• Artificial implants
• Bio implants such as bone or tissue grafts taken from the patient or a donor
• Fat grafting or fat injections
• Injectables fillers such as collagen, HA etc

A cheek augmentation is done when the following conditions exist

• deficient cheek area due to congenital deficiency, age-related bone resorption or facial trauma
• weak cheek structure making face appear drawn and gaunt
• appearance of a fleshy lower face
• bulges under the eyes are more prominent due to cheek deficiency
• unbalanced facial features

• Silicone Implants
• Expanded Polytetrafluoroethylene (ePTFE):
• Polyethylene Implants
• Hydroxyapatite Implants

• Bone Grafts
• Cadaveric Bone Grafts- bone grafts from deceased donors
• Autologous Tissue Grafts (excluding fat) - use of own tissue from elsewhere on your body
• Autologous Fat Transfer (Fat Grafting) - removing surplus fat cells with meticulous extraction methods and to re-implant to the cheek
• Cadaveric Tissue Grafts & Cultured Tissue - Cadaveric tissue grafts derived from deceased donors. 
• AlloDerm – made by removing a thin layer of skin tissue (an allograft) from the 'donor' at the time of death, placing it into an antibiotic solution , processing by removing the epidermis and all of the cells in the dermis
• AlloGraft - provided by both cadaveric and family donors
• Apligraft - cultured from infant foreskin cells and bovine (cow) collagen.

• Collagen - an injectable bovine-derivative (made from cow collagen)
• Hyaluronic Acid
• Injectable Hydroxyapatite Paste - injectable paste forms of HA
• Poly-methyl (methacrylate) (PMMA)
• Hydrophilic Polyacrylamide Gel
• Injectable Silicone (polydimethylsiloxane oil)

• Candidates without any cardiac condition or serious incidence of hypertension
• Candidates without any bone disorders
• Candidates not taking anticoagulants such as warfarin or heparin
• Candidates who are not on Accutane for the past six months or more
• Candidates who wish to improve their external appearance
• Candidates who are physically healthy, psychologically healthy and have realistic expectations from the procedure
• Candidates who seek improvement rather than perfection
• Candidates who are not "overly" skinny, with a major metabolism and have a little extra fat somewhere on the body to spare for augmentation procedures using fat grafting

• Collagen – allergic reactions
• Hyaluronic Acid – allergic reactions
• Injectable Hydroxyapatite Paste - resorption
• Poly-methyl (methacrylate) (PMMA) - allergic reactions

• During the initial consultation, a thorough discussion on the expectations of the patient is understood
• The dental history and x ray studies of the head and jaw are taken
• Photographs are taken for further comparison after procedure.
• The doctor discusses and advises on options of anaesthesia, surgery options, incisions (if any), type of facilities and cost with the patient.
• The doctor provides guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications
• The patient must arrange for transportation and assistance to leave for home after the surgery

Cheek implant surgery (using grafts, artificial implants)

• The patient may seek a copy of the manufacturer’s brochure for the implant

• If the surgeon is planning to make a submental incision, the patient should use an antibacterial facial cleanser for two days before surgery.
• The doctor will perform a physical examination to evaluate the general health, skin and facial structure
• Patients should stop smoking and discontinue all medications containing aspirin or NSAIDs for two weeks prior to surgery
• Patients scheduled for an intraoral approach should rinse the mouth with mouthwash three times a day for two days before surgery.
• The patient should not eat or drink anything for eight hours prior to the procedure.

Fat injections and Injectable fillers

• The doctor will inject a small amount of collagen, usually into the forearm just below the skin's surface, to determine if the patient is eligible for collagen or for certain PMMA treatments.  The injection site should be watched closely for at least 4 weeks for signs of inflammation

• The procedure is performed after administering local anaesthesia with light sedation, local anaesthesia and deep sedation, or general anaesthesia.
• An incision is made in the lower eyelid or inside the mouth
• The implant is placed directly on top of the cheek bone or right below it and checked for the proper look suitable for the patient's features.  It may be removed and further customized several times during the operation. 
• The implant is either sutured or screwed into place. If no sutures or screws are used the cheek is taped or given a head dressing.

The surgery is completed in two hours.

2. Fat injections or fat grafting

• The patient is administered local anaesthesia on the
• donor areas, the areas from where the fat is to be taken and
• the cheek area
• Fat is removed from the donor site, usually the buttocks, abdomen etc, with a small hypodermic needle
• The fat is spun in a centrifuge to remove excess fluids and the damaged fat cells are picked out
• The undamaged fat cells are then
• injected with the use of a separate smaller hypodermic either just under the cheek or deep within the muscle or
• Implanted, taking individual strands of fat cells one by one through minute incisions on the cheek. The incisions are then closed

The procedure is completed in 1-2 hours.

Note -The treatment area is overfilled to allow for absorption.

3. Injectable fillers

1. Collagen
• Local anaesthesia may be administered.
• The collagen is injected using a fine needle inserted at several points along the edge of the treatment site. The patient may feel some minor stinging or burning as the injections are administered, if a local anaesthesia has not been used
• After a bit of collagen is injected, the doctor/nurse immediately massages the area to smooth out the collagen within before it firms up
• The area is slightly overfilled to account for the partial absorption of the substance within a few days.

2. Hyaluronic Acid

• The treatment area is wiped with an antiseptic.
• Local anaesthetic may be used to numb the treatment area.
• HA is injected either by
• serial intradermal puncture technique, where a series of small injections are given with a very fine needle or
• tunnel or threading technique, where the needle is withdrawn as the hyaluronic acid is injected
• The doctor/nurse then lightly massages the area

3. Injectable Hydroxyapatite Paste - injectable paste forms of HA

• The treatment area is wiped with an antiseptic.
• Local anaesthetic may be used to numb the treatment area.
• The paste is injected using a fine needle inserted at several points along the edge of the treatment site.
• The doctor/nurse then lightly massages the area

4. Poly-methyl (methacrylate) (PMMA)

• The treatment area is wiped with an antiseptic.
• Local anaesthetic may be used to numb the treatment area.
• PMMA is injected into the skin by the tunnel or threading technique, where the needle is withdrawn as the PMMA is injected
• The doctor/nurse then lightly massages the area

5. Hydrophilic Polyacrylamide Gel

• The treatment area is wiped with an antiseptic.
• Local anaesthetic may be used to numb the treatment area.
• The gel is injected into the skin by a retrograde technique, where the needle is withdrawn as the gel is injected
• The doctor/nurse then lightly massages the area

All the procedures are done on an outpatient basis.
Following implant surgery

• The patient experiences some swelling and bruising. Bruising will begin to disappear within the first 5-7 days.
• Swelling may last up to 3-5 months
• The tape is removed about a week after the surgery
• Pain and discomfort last for several days following the procedure which can be eased by pain medication prescribed by the doctor
• Facial movements, such as talking and smiling, may be difficult for several days following the surgery
• The patient may feel a degree of numbness that should disappear over 1 to 3 months
• The patient may wear a support brace while sleeping to allow the tissues and implant to heal in the desired position and prevent shifting in the first few weeks
• The dressings usually remain intact for 48-72 hours.
• The sutures, if any, will be removed in approximately 10 days
• The plastic surgeon will give instructions regarding dental hygiene, eating and any restrictions to activities after surgery.

Following fat grafting and filler injections
Fat

• Some swelling, bruising or redness in the donor and recipient sites is seen
• Swelling and puffiness may last several weeks while redness and bruising usually lasts about 48 hours

Filler injections- cellulose

• Temporary swelling and redness in the treated area should dissipate within a few days.
• Tiny scabs over the needle-stick areas is seen which generally heal quickly.

Following implant surgery

• The patient should rest in bed for the first day or two after surgery.
• The patient must sleep with the head elevated for 7-14 days.
• The patient may apply cold compresses, or small ice packs to reduce swelling and relieve discomfort.
• Patients can return to work with the help of camouflaging cosmetics at about 5 days post-op.
• The patient can expect to resume regular activities in about 1 to 2 weeks.
• The patient will be on a liquid or soft-food diet for several days.
• The patient should rinse the mouth with a solution of hydrogen peroxide and warm water two to three times daily
• The patient should avoid sleeping on the face and unnecessary touching of the cheek area
• The patient should avoid vigorous physical exercise for about three weeks
• The patient must not lift anything over 5 lb. and try not to raise anything over the head until permitted by the  surgeon
• The patient must walk as much as possible to reduce swelling and possibilities of blood clots
• The patient must inform the doctor immediately if any of the following occur
• Temperature elevation greater than 101 degrees
• Sudden swelling or sudden discoloration
• Haemorrhage
• Increasing redness and tenderness of the wound edges indicating infection
• Allergic reaction to drugs
• Shifting of the implant

Following fat grafting and filler injections

• The patient must arrange for assistance  at home for 1-2 days
• The patient must get plenty of rest and follow a balanced diet.
• The patient must add more raw fruit to the diet and increase fluid intake to avoid constipation.
• The patient must take pain medication as prescribed.
• The patient must avoid alcohol for 3 weeks as it causes fluid retention
• The patient must start walking as soon as possible, as this helps to reduce swelling and lowers the chance of blood clots
• The patient may shower 48 hours after treatment
• The patient must avoid exposing scars to sun for at least 12 months
• The patient must always use a strong sun block
• The patient must inspect daily for signs of infection
• The patient must stay out of the sun until redness and bruising subsides (usually 48 hours)
• Repeated treatments may be necessary
• The patient must contact the doctor if any of the following occur
• increased swelling or bruising
• increased redness along the treatment site
• severe or increased pain not relieved by medication
• side effects to medications; such as, rash, nausea, headache, vomiting.
• oral temperature over 100.4 degrees.
• yellowish or greenish drainage from the treatment site or a foul odour.
• bleeding from the treatment site that is difficult to control with light pressure.
• loss of feeling or motion.
• sign of abscesses, open sores, skin peeling or lumpiness.