Malar Augmentation vs. Reduction
Medically reviewed by Tuan A. Tran, M.D., M.B.A., F.A.C.S. | Written by Nhuhao Do, B.S. on May 5, 2021
The goal of cheek recontouring is to achieve soft and contoured mid face that is harmonious to the rest of the face. There are two different pathways to cheek recontouring: malar augmentation and malar reduction.
Malar (cheek) augmentation aims to increase volume to the cheekbone area to depict a healthy and slimmer facial appearance. Also, the high and prominent cheekbone can further enhance the appearance of the beautiful eye. There are many techniques to cheek augmentation. Nonpermanent technique may include hyaluronic acid (HA) dermal filler; semi-permanent techniques include fat transfer/grafting and silicone malar and/or submalar implants; and permanent technique can be done with zygomatic sandwich osteotomy for cheek augmentation.
On the other hand, patients with overly protruding malar eminence may seek cheek reduction through malarplasty and/or buccal fat removal to achieve a softer and more youthful appearance. Depending on your cultural heritage and ethnicity, some oriental facial features may be predisposed to exaggerated anterolateral protrusion of the cheekbone. Due to that, the face may appear flatter or have a resemblance of a square shape. Other instances such as with transwoman undergoing facial feminization, cheek reduction may be suggested to smooth out excessive fullness in certain area, while increasing volume in another to achieve a rejuvenated and feminine look.
Who is a good candidate?
A good candidate for cheek recontouring is healthy adult with realistic expectations of what the procedure can help them achieve along with understanding potential risks.
Other attributes that may benefit one from getting check augmentation may include loss of volume in the lower cheek region due to aging. This causes the soft tissue to sag, making the patient appears grumpy and older beyond their age. Some may be born with less eminent cheekbones and would like augmentation for aesthetic factors.
Likewise, one may benefit from cheek reduction if they feel that the outer portion of their cheek is protruding, making their face appear wider and less defined than they would wish for. Patient with mesocephalic skull shape like in Asian patients will be more likely to benefit from cheek reduction as to patient with dolichocephalic skull shape like in Caucasian patients.
Patients undergoing facial feminization can greatly benefit from cheek recontouring. Since, feminine faces often have cheeks that are rounder and more prominent than those found on men. Cheek augmentation can be performed to add more fullness to the cheekbones. While, reduction of the anterolateral zygoma can help contour the profile of the face at the same time, rejuvenating the overall appearance.
If protrusion or chubbiness of the lower cheeks is also a concern, you can read more on jawline recontouring to learn about available options for trimming down the lower third of the face to achieve a more chiseled, v-shape jawline.
Procedure in Detail
Cheek recontouring can be performed with different techniques of cheek augmentation in conjunction with cheek reduction for an overall harmonious middle third of the face.
Fig. 1. Dermal filler injection to cheeks.
- Dermal Filler – a type of thick HA dermal filler by Juvederm®, known as Voluma XC has been adored by the aesthetic community to boost the volume of the cheeks to beautifully contour the face and restore firmness to the area. Dr. Tran uses a fine needle to inject the filler to target areas for instant results. HA filler can be safely and slowly metabolized by the body over time with lasting results of up to 2 years.
- Fat Transfer/Grafting – fat can be harvested from unwanted areas in the patient’s body, this may include but not limited to the abdomen, flanks, back and thighs. Dr. Tran will purify and reinject the fat cells to target areas like the cheeks to increase fullness and highlight the cheekbones. With this technique, Dr. Tran can also conceal the dark circles and nasolabial grooves. During the first 6 weeks, the body will recover from the procedure and absorb approximately 30-40% of the fat transfer. Therefore, he will inject more fat than needed to account for this loss. After this period, the fat that survived and connected to its new blood supply will remain there permanently and behave like any other fat cell in the body. It will respond to normal weight gain and loss like other fat tissues.
- Facial Silicone Implants – Depending on the area of sagginess or lack of volume, Dr. Tran will recommend whether malar, submalar or both malar and submalar implants would be beneficial to achieving your desired results. Whichever you choose, the silicone implant will be inserted via a small incision made inside the inner cheek just right above the upper jaw. Dr. Tran will make a small pocket in the cheek to hold the implant in place. With its supple and permanent effect along with the ability to surgically remove or replace it any time, silicone implant is an effective solution to naturally enhanced the cheekbones.
- Zygomatic Sandwich Osteotomy (ZSO) for augmentation: this technique allows for precise permanent recontouring of the cheekbone. Dr. Tran will make a vertical osteotomy of the zygoma through a small incision inside the mouth. For augmentation, he will insert spacer material in between this region of bone and secure it with a miniplate system. If desired post-surgery, the procedure can be easily repeated or adjusted with the miniplate system set in place. Because there is no capsule formation with this technique, the risk significantly reduced for any danger of sensory or motor nerve branches.
- Zygomatic Sandwich Osteotomy (ZSO) for reduction: malarplasty can also be performed with ZSO technique. However, the technique for cheek reduction is different in osteotomy design, where Dr. Tran will make a second vertical cut, remove bone, infracture the zygoma, retrude, and rigidly fixate the cheekbone without the use of a spacer. The outcome of this procedure is achieving a smaller face, three-dimensional younger look, as well as improved frontal and profile contour of the face.
- Buccal fat removal: partially removing the buccal fat under the cheekbone can also help contour the profile of the cheek. This procedure can be done in-office under local anesthesia. Dr. Tran will make a small incision inside the mouth to access and remove a portion of the buccal fat pad, leaving a partial pad left for functionality purposes.
Recovery time for cheek recontouring varied with each procedure and patient. An overview of recovery period for each procedure can be examined bellow in order of the least downtime to most downtime for comparison purposes. However, it is best to discuss with Dr. Tran and his team for more personal recommendation and in-depth post-op instructions.
- HA Dermal Filler – patient may resume daily routines immediately after the procedure. Result can be seen immediately and can last for up to 2 years.
- Buccal Fat Removal – patient may return to work 1-2 weeks and start exercising after at least 1 week. Final results can be seen after 4 months.
- Fat Transfer – recovery time will vary depending on the area of liposuction. Generally, patient may return to work after 2 weeks and gradually resume their daily activities. Patients should see the final results after about 6 months.
- Facial Silicone Implant – patient may return to work and light activities within a week but need to avoid strenuous activities for 4-6 weeks. Full recovery and optimal facial improvement take 3-4 months to set in.
- Zygomatic Sandwich Osteotomy/ Malarplasty – patients may resume light activities and return to work after 1 week from the surgery. After 3 weeks, patients may start exercising and resume normal activities. The results of malarplasty will be definitive after six months.
Cost and Consultation
If the results of cheek recontouring are what you are looking for, contact Tran Plastic Surgery through our website, Tran Plastic mobile app or call us today at 714-839-8000 to schedule your complimentary consultation. We will walk you through the process and help you determine the procedure and technique that will best deliver your desired aesthetic appearance.
Bettens, R., Mommaerts, M., & Sykes, J. (2002). Aesthetic malar recontouring: the zygomatic sandwich osteotomy. Facial Plastic Surgery Clinics of North America, 10(2002), 265-277.
Facial implants facial balancing and enhancing. American Society of Plastic Surgeons. Retrieved from https://www.plasticsurgery.org/cosmetic-procedures/facial-implants/procedure#:~:text=Cheek%20implants%20are%20most%20often,or%20one%20within%20the%20hairline.
Mommaerts, M.Y., Abeloos, J.V., De Clercq, C.A., Neyt, L.F. (1995, February 23). The ‘sandwich’ zygomatic osteotomy: technique, indications and clinical results. J Craniomaxillofac Surg. (1):12-9. doi: 10.1016/s1010-5182(05)80248-3. PMID: 7699077.