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Revision Surgery is
the procedure to correct or change the results of a prior cheek
enhancement procedure. Reasons may include any one or a
combinations of the following:
How Cheek
Augmentation (Cheek Implants) Surgery Is Performed
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Depending upon the amount of augmentation and the
technique or material used (if applicable), cheek
augmentation can last about 1 1/2 to 2 hours, depending.
Possibly more if bone grafts, reconstruction, revision
surgery or additional procedures are performed. |
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First, you will have
monitoring pads attached to you so that the surgical team can
properly monitor your vital statistics before, during and after
your operation. When you are brought to the operating
room, electrodes will be plugged into these pads which are
connected to the monitoring equipment. However, your heart
and oxygen saturation may be monitored before you are brought
into the O.R. at the same time your IV is inserted.
I.V Insertion
You may or may not have already been hooked up to the saline IV
drip and are awaiting the O.R. to be prepared for your surgery.
Other surgeons wheel you into the O.R. and insert your IV then.
If you had been given an oral sedative or valium prior you
usually could care less what they are sticking in you. If
you haven't been given a sedative, the initial first few minutes
until you are anesthetized may be stressful.
Having an IV
inserted feels sort of like blood being drawn, but for a shorter
period of time. It's the initial placement of the IV
catheter that may sting a bit. Some patients get it in the
crook of the elbow, some the hand. I dislike the ones in
the hand as it's a nasty place for a bruise to be, at least with
the arm you can hide it, it all depends upon your veins
though. So if your veins are not very prominent this can
be a problem. Some patients even have to be catheterized
in the neck.
After the needle is
injected into the vein, it is pulled out and a little Teflon
tube is left in your vein. This intravenous tube is called
a catheter. However many people consider the whole access
system a catheter. Let's call the access system a
'catheter hub' for simplicity. This hub usually contains
the catheter, a needle, a flashback chamber and tubing connected
with a luer lock.
The hub acts as an
injection port and is taped to your skin to keep it from getting
knocked out. Medications can be injected into the body via
this port or be connected the tubing to allow automatic infusion
of drugs and intravenous fluids with a computerized drip system.
In short, the IV is for a saline drip to keep you hydrated and
also acts as a vascular doorway for medications, many times
including anesthesia. You may or may not receive some
medications to help you relax or feel sleepy at this time.
This can help with pre-operative anxiety if you were not given
an oral medication to do so.
Monitoring Equipment
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Regardless of the order and manner in which they insert
your IV, after you are placed on the operating table
they will talk to you for a minute or two and hook you
up to the heart monitoring and oximeter machines,
possibly wrapping your legs with compression cuffs and
other final preparations. Your vital signs will be
monitored, including your blood pressure, body
temperature, pulse rate/heart beat, and your breathing
rate -- all very important factors to determine
if you are okay while under anesthesia. The O.R.
staff will also check your blood pressure. |
You have more
than likely had your blood pressure taken before with the
use of a cuff which inflates firmly around your arm.
You will also have an oximeter clip (or strip) placed on
either your finger, your earlobe, or possibly on your big
toe. The oximeter machine monitors the oxygen/carbon
dioxide saturation in your blood -- this is very
important. Your anesthesia and saline will also be closely
monitored and meticulously controlled. You may also
have intermittent pneumatic compression sleeves placed on
your legs to decrease the risk of Deep Venous Thrombosis (DVT)
and subsequent pulmonary thromboembolism. Heavier
patients may especially benefit from this. These
devices are inflatable sleeves for your legs which are
either thigh high or knee high that inflate and deflate to
keep circulation optimal. You may also have heat
lamps or heated blankets, depending upon the surgeon, your
temperature, etc. Your vital statistics must be
determined as stable before going any further.
Anesthesia Types Used In Breast Reduction Surgery
If you and your surgeon have chosen an IV Liquid Sedative,
they will either manually insert medications with a hypodermic
into a Y site or injection port along the length of the silicone
tubing connected to your catheter hub/IV or more than likely
your anesthesiologist will attach a bag of anesthetic or use a
computer-controlled drip system. The computer system
automatically infuses a few drops of anesthetic every few
seconds into a drip chamber where it mixes with the saline.
The drip crate can also be controlled via the roller clamp.
Flow regulators can also regulate the flow rate.
When the anesthesiologist
releases the roller clamp the mixture starts heading towards
your body. The effects of the anesthesia are felt soon
after injection or opening the roller clamp--afew seconds in
fact. It feels like heat going into you veins then
creeping up your arm; then it jumps from your shoulder to a
metallic-like taste under your tongue and then you are
blissfully anesthetized.
If you have chosen Gaseous-state anesthesia (Twilight, Gaseous
General)
Your mouth and nose will be covered with a mask and you will
usually be told to count back from 100. You will usually
remember getting only to about 96 before falling fast asleep.
Then, the anesthesiologist will more than likely intubate you.
Intubation usually involves an endotracheal tube down your
throat to deliver gaseous anesthesia to your lungs.
However, some surgeons give you a little IV sedation and then
intubate you and switch over to gaseous sedation. Both of
these maneuvers eliminate the horrible experience of having a
tube shoved down your throat while you are awake, which is
unheard of in this day and age.
Another option is with the use of a laryngeal mask airway (or
LMA). This is a lot like the older intubation for General
but there is a shorter tube and a little balloon the size of
your two thumbs at he end. The tube holds your tongue down
and of the way so it does not obstruct your breathing and the
balloon inflates and bocks fluid from entering your windpipe
either from saliva or stomach acid and makes a seal so the gas
can be delivered to your lungs. It is basically like a
diaphragm for your windpipe. With the older intubation you
have the pleasure of having a tube down your throat but you
don't usually remember it going in. You may wake up with a
raw throat with either but it is usually less so with the LMA.
You may wake up with an irrigated and dry throat regardless
because canned or cylinder air (scubadiving tanks as well) is
d-r-y. There is no moisture in these tanks. It is
your turbinate structure (three little fleshy flaps in
your sinuses) inside your nasal structure that mostly warms and
humidifies the air which you breathe. When you have to
humidify your air, your body needs more moisture. The
saline drip will assist in this as well.
Another option is
with silicone tubing which is placed in the nose, however this
is rarely used as surgeons and anesthesiologists prefer that the
windpipe be protected and the tongue held down and throat firmly
held open for longer procedures. Be sure to ask your
surgeon which method he will be using if you are interested.
Regardless of which method, the gaseous anesthetic is mixed with
oxygen and this is how you will breathe during your surgery.
You may then be marked with a magic marker type pen for the
implant placement areas and incisions if your placement is to be
performed extra-orally.
Sterilizing The Surgical Field
The O.R. staff will then scrub your face
and neck (and other areas if you are having other procedures)
with a 7.5% Betadine Surgical Scrub. The O.R. staff will
then rinse off the area with sterile gauze soaked in saline and
then paint your surgical area with the 10% Betadine Solution
which resembles a brownish, iron-colored liquid. This will
sterilize the area by killing surface bacteria, fungi, protozoa,
viruses and yeasts. A common bacteria found on the skin is
the naturally occurring Staphylococcus aureus, or simply
Staph) and decrease your risks of an infection.
The Surgery
You will be injected with a solution of Lidocaine, epinephrine
and saline. The epinephrine is a vasoconstrictor. This
will impede your skin's ability to bleed excessively by
narrowing the bore of the blood vessel.
The incision will be made in the predetermined placement, the
implant situated directly on top of the cheek bone (or if need
be, right below it) and checked for the proper look suitable for
the patient's features. It is possible that it may be
removed and further customized several times during the
operation. The implant either sutured or screwed into
place. Sometimes percutaneous sutures are used.
This is where they stick partially out of the skin and can be
removed later on by tugging gently on them after they have
partially dissolved within. They can also be sutured with
dissolvable stitches inside the surrounding tissues. Even
still, the implants may not be sutured in at all, only the
pocket, relying on your body's collagen to secure into place.
If no implant/sutures are used you will more than likely have
tape or a head wrapping that is worn at night to help it heal
properly in the face.
The surgical team then performs a sponge
and instrument count and your surgeon then closes your incisions
with, more than likely, a non-dissolvable type suture. You
may have an antibiotic-soaked piece of gauze placed between your
upper molars and, gums and your inner cheek and
perhaps a pressure dressing placed around your head such as you
would see in a face lift patient or a neck liposuction patient.
If you are not familiar with this look it involves wrapping a
dressing around the top of your head to underneath your chin,
sometimes slightly over your ears. Of course there may be
differences in surgical technique depending upon the preference
of your surgeon.
You are then gently awakened and brought into the recovery room
where the recovery nurse will monitor your vital stats until you
are ready to be released. This is dependent upon the
individual but may take up to two hours. You have had injections
of local anesthesia and this will numb the inside of your mouth.
Take care not to bite the inside of your mouth as you will not
feel it if you lacerate the mucosa. Your face may feel
tight and quite tender as the anesthesia wears off. You
may even feel emotional or upset, this will depend upon your
body's reaction to anesthesia. You may also experience
rigors, or "shivering." This may feel uncontrollable and
is usually from the medications -- more than likely epinephrine
that is used as a vasoconstrictor. The recovery nurse
usually has wrapped you in a warm blanket but if not, request
one. It certainly makes things more tolerable. You may
even be fortunate to have heating lamps.
Some patients feel nothing different although if you have had
General you may feel a little sick, hopefully your surgeon gave
you something to lessen this. Your prescribed medication
should alleviate this pain and discomfort. However, if you
believe your pain to be out of the ordinary once you get home,
call your surgeon or the on call staff immediately. You
will be driven home by your spouse, significant other or friend
as you will not be able to see, much less drive yourself home.
For Injectable Products
There is sometimes an injection into the nerves cluster which
will numb the lower half of the face. Injections of
whatever product was discussed beforehand will be implanted via
a hypodermic. You may be asked for input and given a hand
mirror. Do remember that there may be swelling if these
products are suspended in saline. A majority of the
swelling will subside within a few hours if this is the case.
Products such as injectable hydroxyapatite or hydoxyl-apatite
like Radiance FN (or Radiesse), Reviderm Intra, Artecoll and fat
grafting. You will more than likely be able to drive yourself
home if only local or regional anesthesia is given. If you
were given an oral sedative it is unlawful, and dangerous, for
you to drive yourself home.
Cheek (Malar) Implants & Other Augmentation Options
Once upon a time only silicone implants and bone grafts
were used, now there are many options. Believe it
or not, cheek implants have been around since about
1956. Here is a list of the most popular methods
and products for cheek augmentation, including
autologous (from your own body) mediums, injectable
fillers and implants as well as the material type and
manufacturer information. |
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Bone Grafts:
There is a degree of resorption. There may be a longer
recovery time with bone grafts and an increased risk of bone
infection as well as excessive calcifications. The donor
site, if using your own bone, is also an issue which can be
subject to a secondary site infection or other complications.
Below is an explanation of how bone grafts are incorporated:
"1) Induction: Activation of host osteoblasts
and differentiation of primitive mesenchymal cells into
chondroblasts and osteoblasts.
2) Inflammation: Graft invaded by PMN's and its
cellular elements are degraded. Neurovascularization
and mesenchymal proliferation follow. Small avascular
autografts can become vascularized within 4-5 days.
3) Soft tissue callous formation: The cellular
matrix of the invading granulation tissue becomes more dense
and the vascularity increases. Osteoclasts continue to
remove dead bone, while chondroblasts deposit a new matrix
of chondroid on the old bone; this begins to calcify.
In cortical bone there is a preferential removal of necrotic
Haversian systems rather than lamellae leading to an
increased porosity of the graft.
4) Hard callus formation: Osteoclasts continue to
remove dead bone and also begin degrading calcified
cartilage, while osteoblasts lay down membranous bone to
replace it.
5) Remodeling: Graft is remodeled into lamellar
bone and a medullar canal is established". credit:
Yale Medical University Core Curriculum
Cadaveric Bone Grafts:
These bone grafts come from cadavers (from deceased
donors) and are used the same way as your own. The chance
of rejection is slightly higher but very rare. The way a
cadaveric bone graft is incorporated is the same as above but
without, of course, the donor site risks and complications.
Autologous Tissue Grafts (excluding fat):
This is the use of your own tissue from elsewhere on your body
and is usually not the best choice for cheek augmentation.
Although there is no chance of rejection as it is your own
tissue, there is a high degree of absorption as well as the risk
of an additional site infection or contour irregularities at the
donor site.
Autologous Fat Transfer (Fat Grafting):
Fat transfer, more commonly known as Fat Grafting, is also
referred to as free fat transfer, autologous fat
grafting/transfer/transplantation, liposculpture, lipostructure,
volume restoration, micro-lipoinjection, fat injections, f/g and
even the "Space Lift(R)". For Simplicity, Fat Grafting
will be used from here on.
Fat Grafting or Fat Transfer is the procedure to remove surplus
fat cells with meticulous extraction methods and to re-implant
where needed - to the
cheek and other places such
as the lips, nasolabials (mouth to nose folds), undereyes,
cheeks, temples, etc. This is a very exciting
procedure as it is not incredibly invasive, produces natural
results, but does create a moderate amount of swelling.
However, fat can be resorbed by the body and sometimes
only a certain percentage is permanent although newer techniques
are resulting in increased longevity. Although it seems
the longevity of fat in the cheeks is actually pretty
good if performed correctly. If you would like to know
more please visit the
Fat Grafting page.
Cadaveric Tissue Grafts & Cultured Tissue: Cadaveric
tissue grafts are derived from deceased donors. Although
most of this tissue was "donated", some companies have
chosen to profit by their donations and sell the tissue at
exorbitant costs to patients who desperately need it. In a
2 billion dollar a year market, many times these tissue grafts
are not available to or are too expensive for burn patients --
yet find their way in plastic surgery operating rooms. On
the other hand, companies such as Advanced Tissue Sciences,
BioSurface Technology, Dermagraft-TC, Genzyme, and Organogenesis
(Graftskin(TM)) extract cells from purchased foreskins which
have been excised and sold by hospitals to culture skin in petri
dishes and large trays. These products were originally
processed and approved for skin replacement in patients with
large burns or diabetic ulcers.
AlloDerm (Lifecell Corp.):
(technically: Acellular human cadaveric dermis) AlloDerm
is made by LifeCell Corporation in Palo Alto, California.
The Tissue Banks surgically remove a thin layer of skin tissue
(an allograft) from the 'donor' at the time of death, place it
into an antibiotic solution and transport it to LifeCell Corp.
There, the allograft is processed by removing the epidermis and
all of the cells in the dermis which may cause rejection.
The resulting AlloDerm graft is the protein framework without
any of the donor's DNA. This material is also used for
dermal augmentation, to cover implants on the cheek, chin and
nose, as well as augmentation of the lips (mobile soft tissue).
It reportedly lasts up to two years and in some instances,
indefinitely if proper collagenation of the scaffold occurs.
Website:
LifeCell Corp.
AlloGraft: Also provided by both cadaveric and family
donors. This product is typically used for skin replacement and
"slings" for patients suffering from a "falling bladder" or
injectable form for urinary incontinence. Has been used for soft
tissue augmentation.
Apligraft: This product is cultured from infant foreskin
cells and bovine (cow) collagen. The tissue is primarily
used for the replacement of skin in patients needing
reconstruction. Although, it has been used for soft tissue
augmentation.
Silicone Implants:
Solid silicone has been used as a material for facial implants
since about 1956. The silicone facial implants are solid,
yet flexible and very durable. They are manufactured in
different durometers (degrees of hardness) to be soft or quite
hard. These implants are designed to enhance soft tissue
areas and not the underlying bone structure. They
are usually easily removed as they are quickly encapsulated by
scar tissue. Some surgeons affix
cheek implants to the bone by way of one or several titanium
screws per implant. When used for cosmetic purposes this implant
rarely exhibits a biochemical reaction. However, when used
in functional surgeries such as TMJ disorder or hip replacement,
fragments can rub off of the implant and cause inflammation
within the joints.
Expanded Polytetrafluoroethylene (ePTFE):
These implants are porous and utilize the benefits of tissue
integration as well to keep it in place. Not as firm as
the more harder silicone implants. There is less bone
resorption underneath (ePTFE) implants as opposed to silicone
implants. When used for cosmetic purposes this implant
rarely exhibits a biochemical reaction. However, when used
in functional surgeries such as TMJ disorder or hip replacement,
fragments can rub off of the implant and cause inflammation
within the joints.
Polyethylene Implants:
These implants are bio-compatible and reportedly place no extra
stress on the body or effect it whatsoever. Not saying
that Silicone does, it's just another option for your
cheek augmentation. They are porous and rely on tissue
integration instead of titanium screws for stability. These are
more difficult to remove but do produce excellent results if
placed correctly.
Hydroxyapatite Implants:
Medical Science has come up with a way to alter coral into an
even closure match to bone and that is called Hydroxyapatite
or simply, HA. It has both the porous structure and
chemical make-up of bone so that the body accepts it
wholeheartedly and even incorporates normal tissue integration
and not capsulization like synthetic implants. A patented
process converts Calcium Carbonate into hydroxyapatite while
maintaining the three-dimensional integrity of the coral
yielding Coralline Hydroxyapatite (CH). All the proteins
are removed by intense heat. This renders the structure totally
non-immunogenic so it becomes a nearly perfect bone lattice.
Closest to bone grafts but without the bone.
So how exactly is HA made? "The synthetic material is prepared
by heating the coral-which is essentially calcium carbonate
with ammonium phosphate at more than 200º C for 24 to 60
hours to obtain about 95% Hydroxyapatite. The material is
processed into block or granular form and sterilized by gamma
radiation".
(American Chemical Society)
How long does it last you ask? "The natural porosity of the
material does have the drawback of reducing its strength, notes
David C. Mercer, Interpore's president and chief executive
officer. But the porous structure provides room for bone tissue
to immediately grow into the pores of the implant. However, the
material is only partially resorbed and replaced by natural
bone. The company is now evaluating in pre-clinical studies a
related new product that has a higher resorption rate".
(American Chemical Society) *Also
available in an injectable or spreadable, non-porous paste.
Injectable Tissue Augmentation Products:
These products offer ease of placement with less downtime
although the permanent micro-implants are not easily removed.
Some products are temporary and could be used to "try on" what
cheek augmentation would look like although asymmetry is
possible as the injectable solution is, of course, not
pre-formed and subject to migration within the first few minutes
to days.
References
Photo: Surgiform Technology, Ltd.
Paul Sabini, MD; Anthony P. Sclafani, MD; Thomas Romo III, MD;
Steven A. McCormick, MD; Rubina Cocker, MD - Modulation of
Tissue Ingrowth Into Porous High-Density Polyethylene Implants
With Basic Fibroblast Growth Factor and Autologous Blood Clot
Yale Medical University Core Curriculum
Dept. of
Otolaryngology, UTMB, Grand Rounds, Chin and Malar Implants,
September 6, 1995 Resident physician, Michael Bryan, M.D.
faculty, Karen Calhoun, M.D.
Dept. of Otolaryngology, UTMB,
Grand Rounds, Chin and Malar Implants, April 17, 2000;
Ravi Pachigolla, M.D. faculty, Karen Calhoun, M.D.
Merriam-Webster Medical Dictionary
American Chemical
Society
Silver, WE, Malar augmentation. Facial Plast Surg
1992 Jul;8(3):133-9.
Constantino PD; Freidman CD
Synthetic Bone Graft Substitutes. Otolaryngologic Clinics of
North America 1994 Oct; 27(5):1037- 1074.
Incision Placement Options
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Please
review your options. Do not go into a surgeon's
office knowing only about one incision placement.
Implants have four main incision placements with an
added placement if a face lift is performed. Then
the implants are placed using the face lift incisions.
Most surgeons offer only one incision option due to
personal preference. Be sure to ask your surgeon
at your consultation so there is no misunderstanding
beforehand. |
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Coronal:
This one is the older and less used incision, although good
if you are having a face lift as well. This is where the
surgeon makes an incision in the hairline.
Subciliary (intra-ocular):
This one is done through the eye. An incision is made
through the inner part of the lower eyelid, above the cheek.
This incision placement has an additional risk of ectropion
(eyelid gaping) if performed incorrectly.
Preauricular:
This incision is performed near the auricle of the ear. It
can be made in front (with an obvious scar), above within
the hairline, or below hidden by the lobe.
Intraoral:
This incision is placed within the upper portion of the
inside of the mouth. It is located between the upper gums
and the cheek. This is beginning to be the incision
placement of choice for most surgeons. Although it has the
advantages of no visible scar, it runs the risk of higher
rate of infection due to the bacteria in the mouth.
Also, be sure to tell your doctor if you smoke or have any
gum disease or cavities. These two could cause an infection
as well as significantly impede healing.
Incision Care and Scar Lessening
Intraoral incisions have a higher rate of infection so please
take care to be sure all meats are cooked thoroughly, this
includes no sashimi (sushi), steak tar tar, even seviche/ceviche.
Also be sure that all raw fruits and vegetables are thoroughly
washed or avoid them altogether until your incision is healed.
No tonguing the incision or touching it with your fingers or any
other object unless specifically told by your surgeon (i.e.
sterile antibacterial ointments with a sterile cotton swab).
Extraoral scars may be lessened with the use of silicone gel
sheeting-backed foam squares which your surgeon may use as
padding under your chin in conjunction with your support
garment. Some surgeons simply use Steri-Strips which may
work equally as well.
Some surgeons choose tissue glue for
extraoral incisions, whereas many use conventional suture
material. If no post-operative therapy was used
immediately after, you may choose to use scar gels such as
Maderma or silicone
sheeting. Please see our
Scar Treatment section for more
information.
Injectable
Fillers
Injectable products
for cheek augmentation can deliver immediate results and can be
in many cases, very rewarding. Some are temporary and can
be used as a try on to ascertain if you'd even like an enhanced
cheek before actually going through with a more permanent
procedure. There are no incisions for injectables but you
will have small pin pricks which may leave needles marks.
Swelling will be an issue, the severity depending upon the type
and amount of product.
Implant Placement, Bone Screws & More
The number one reason for a revision surgery regarding cosmetic
reasons is dissatisfaction from improper implant placement.
The two main placements are malar and sub-malar.
Malar: outer
upper cheek area giving that chiseled, runway model look.
Sub-malar: the
lower or mid-cheek region to help fill out a sunken in face.
The face seems to become gaunt as we age and many people
seek this placement for rejuvenative properties.
Although a more natural appearance can be achieved with fat
grafting which replaces your lost volume with your own fat
stores. Fat grafting, or other injectables such as
Sculptra, Aquamid, etc. can also be used for malar
augmentation. I have had fat grafting and Sculptra,
plus a Feather Lift to gift me more prominent cheeks.
Malar/Submalar combos:
This is as it sounds, a combination of the two above. Some
patients desire augmentation in both areas and can
get both if they wish it. Please discuss this with your
surgeon - view photos of both placements by him or her. Have
him or her explain to you the different looks one receives
with either placement or a combination of both.
Sizing
The second reason?
Too big or too small of an implant. In common augmentation
cases, 4mm thick implants are used. It is possible that
one may need more and these implants are easily ordered as is,
custom-ordered or carved from solid medical grade implant
silicone or other type blocks to suit your individual needs.
Also, there may be in-office sizers to determine the
augmentation size pre-operatively although do not rely on these
as they are often hard to place for a realistic preview.
Saline injections can be used and are a little painful but
helpful. They will not give you a superlative idea of
definition, but they can let you know what it looks like to have
cheeks before you actually get them.
Implant Fixation
The third reason? Displacement, i.e. "shifting." The main
reason implants shift is because of improper pocket formation.
You do not need fixation with screws to hold your implant in
place. A perfectly sized pocket can be made and hold your
implant in place.
For those of you who
insist on fixation, titanium screws may be the answer. These
screws can be used to secure most solid silicone and other types
of malar implants into your underlying bone to fixate the
implant and prevent it from shifting or falling within the face.
A few patients report occasional cold sensitivity when screws
have been utilized. This is usually remedied by
ascertaining that the screws are placed away from any
nerve clusters.
Another option is permanent or resorbable suture fixation. The
implant can also be fixated with a non-resorbable (permanent) or
resorbable suture material onto the periosteum. The
periosteum is thick and is often used in chin implant fixation.
It can successfully be used with cheek implants as well.
Scar Capsule Formation
As with any foreign body, a scar capsule may form around the
implant. Discuss with your doctor his preferred implant material
and brand of choice for further information. This should
not effect the cosmetic results of your cheek implant as it can
with breast implants. Cheek implants are hard and will not
distort under the contraction of a fibrous membrane.
The Key To Successful Cheek Augmentation
Most surgeons are able to skillfully place your implants, secure
them and send you on your way to satisfaction. However
beware the surgeon who does not stay on the bone. This is
important. If the implant is right under the skin it is more
palpable and has an increased rate of infection and shifting.
They must also make the pocket the correct size. This is
not breast implant surgery where the pocket is made to be roomy,
with malar and submalar implants this can cause the implant to
heal in place improperly or shift afterwards. Thus a
proportionate pocket must be made to accommodate the implant
itself and nothing more.
Cheek Augmentation Recovery: What To Expect
Initial Recovery: Anesthesia
After you are awakened and brought into the recovery room, the
recovery nurse will monitor your vital stats until you are ready
to be released. This is dependent upon the individual but
may take up to two hours or more. You will feel quite
tender and possibly confused as the anesthesia wears off.
If you feel any discomfort you may want to ask for a pain
reliever which you will more than likely have been asked to
bring with you. You may even feel emotional or upset, this
will depend upon your body's reaction to anesthesia.
You may also experience rigors or shivering. This may feel
uncontrollable and is usually from the medications, more than
likely epinephrine that is used as a vasoconstrictor, and the
cold saline which will have been introduced into your system for
the last few hours, and still may be. The fact that the
operating room is usually very chilly, surely does not help
matters in this regard. The recovery nurse usually has
wrapped you in a warm blanket but if not, request one. It
certainly makes things more tolerable. You may even be
lucky enough to have heating lamps! Some surgical theaters
are more like the dollar theater rather than IMAX, so ask first.
Some patients feel nothing different than waking up from a good
night's rest. Although if you have had General you may
feel a little sick, hopefully your surgeon gave you something to
lessen this. Although I was prescribed Zofran, I forgot to
take it and got sick as soon as I got into recovery. Your
prescribed medication should alleviate any pain or discomfort.
However, if you believe your pain to be out of the ordinary once
you get home, call your surgeon or the on call staff
immediately. You will be driven home by your spouse,
significant other or friend as you will not be able to see, much
less drive yourself home.
What Will I Look & Feel Like? PLEASE READ!
If you have had cheek implants, you will notice your cheeks are
swollen, firm and possibly bruised. Your tissue will soften up
and your swelling will subside. The firmness is from the
swelling which is essentially fluid retention in your tissues.
This is a natural reaction to a wound of any sort, it is your
body's way of repairing it self. The cold compresses
in the first 48 hours, or for comfort thereafter, will
significantly lessen the swelling, as will keeping your torso
elevated.
If you have had injectables, the swelling may be less, however I
have seen injections cause great swelling. Bruising is
commonly less, but of you develop bruising don't be alarmed.
Your cheeks may also be firm as well.
As far as what you will first look like... You may feel you look
like a "pumpkin head", many patients on our message boards feel
this way. I personally liked my swelling but I didn't have
implants, I had fat. Marc, my fiance, had implants and was
swollen on one side more than the other for many months.
He had good days and bad days. This will pass, remember
your results aren't near being seen. Give it time. Don't jump
to conclusions just yet, you will probably not like them at
first and think your cheeks are too big. Please be
patient.
Additional Plastic Surgery Procedures
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Many times facial harmony can be achieved with simply a
cheek enhancement procedure, however sometimes it isn't
even your cheeks at all, other times other procedures
may help you achieve a more balanced profile.
Please do not feel that these procedures are ever
necessary, think of them as information made available
for your research. |
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Facial Liposuction Including Submental Liposuction
Facial Liposuction or sub-mental or sub-mentum liposuction is
the removal of fat from under the chin from either an intra oral
incision or and extra-oral (transdermal) incision.
Sometimes this is called a "double-chin". This procedure
can significantly reduce the appearance of excess facial fat
causing an overweight or heavy appearance, a nonexistent chin or
even a larger nose. This can be a result of aging,
obesity, or heredity.
Some patients even request or may benefit from both sub-mentum
liposuction and a chin implant to complete the look, if needed.
The removal of this excess fat pocket can significantly define a
lower facial structure.
Some patients may even have their jowl fat removed along their
jaw line. If it is the lower cheek fat you desire to
remove such as if you believe you have "chipmunk" cheeks or a
very round face that seems to be there to stay, perhaps you'd
like buccal fat extraction (below). Please see the
Facial Liposuction Section on the Facial Plastic Surgery
Network website for more information on submental liposuction.
Buccal Fat Extraction
Buccal fat extraction, usually pronounced BUCK-ull, like a
belt buckle, is the procedure to remove the fat pads that
augment the lower cheeks. If you purse your lips to
whistle or when you see someone drink through a straw you will
usually notice a more chiseled, hollow look. Buccal fat
removal is also a procedure that is often sought to remedy
fleshy cheeks. However, even without buccal fat removal
many persons in their late 20's to early 30's begin to naturally
see this thinner-cheeked appearance as they age. Hence,
more reason to fully research your hereditary facial structure
and calculate your age versus fat loss before committing.
This is actually a commonly performed procedure in conjunction
with cheek augmentation. Please see the
Buccal Fat Extraction Section on the Facial Plastic Surgery
Network website for more information.
Rhinoplasty Or "Nose Job"
Rhinoplasty is the surgery of the nose to define, reshape or
create symmetry through out the face with the nose as the center
of attention. This procedure is a very delicate and
difficult operation and one should not rush into this surgery
without fully preparing themselves, emotionally and mentally for
it. Plus, not all surgeons are capable of giving you
a wonderful nasal result. So please research your surgeon
carefully.
Chin Augmentation
Chin augmentation, or mentoplasty, is the use of a
synthetic or biological implant to augment, or make the chin
more symmetrical. It can give balance to an otherwise less
defined face. The chin is the base of the face and if
there is deficiency, balance will not be present.
Some surgeons will draw or paint on a photo of your face to show
you what the change would be or utilize computer imagery to help
portray the possibilities. However, you mustn't rely on
the accuracy of the surgical outcome when computer imaging is
utilized. The image is only an approximation. Chin
augmentation can be very subtle and beneficial when performed
correctly. When it is not, it can be very obvious and
unflattering. It also may be that the face needs
Mandibular (jaw) with chin augmentation to balance out the
features either in addition to or instead of simply mentoplasty.
A qualified plastic surgeon can help determine your needs by
examining your facial structure and photographs.
Jaw Augmentation
Also known as mandibular augmentation is the use of
synthetics or biologicals to augment, or make the jaw bone
structure of the face more prominent. It can give balance to an
otherwise less defined face or further augment an already
existent mandibular structure.
We mostly think of a large jaw as being masculine - and
it is. Women need less of a defined jaw than a man would
but a weak jaw can take away from an otherwise beautiful face.
Even if all of your other facial features were close to ideal, a
weak jaw takes away the sense of symmetry and balance. A
weak jaw (considered the mandibular area) can make a
normal nose appear large and an already prominent nose seem even
larger. It may also give the appearance of a 'fleshy'
neck. On the other hand a too prominent jaw may give the
appearance of being unbalanced and if you are a woman,
masculine. The goal should be a balanced relationship
between the structure of the face, unless you would like a
signature feature.
Neck Lift
A Neck Lift, or platysmaplasty and even submental
platysmaplasty,
is a surgery designed to reduce the loose look of sagging skin
in the neck area and under the jaw line. Some
patients who complain of having a fleshy neck, jowls, or a
"turkey waddle" can benefit from this procedure. Many
times patients choose to have a neck lift with their face lift,
chin or jaw augmentation procedure.
These four procedures can be performed in conjunction with one
another for a complete transformation. |
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