Loading
Procedure guide · Face
Cheek ImplantsCheek implants are solid, shaped pieces of silicone or porous polyethylene placed directly onto the cheekbone through an incision inside the upper lip, to add permanent projection or to fill a hollow beneath the bone. The operation takes 45 to 90 minutes, usually under general anaesthesia, and implants are normally fixed to bone with a small screw so they cannot shift. Swelling settles over 3 to 4 weeks and the final shape appears at 3 months.
A cheek implant is a solid, pre-shaped piece of biocompatible material designed to sit on the surface of the cheekbone and change the shape of the face by changing the shape of the skeleton beneath the skin. It is worth being precise about that description, because the word implant carries associations from breast surgery that do not apply here. A cheek implant contains no gel and no liquid, cannot leak or rupture, and has no shelf life. It is a firm, rubbery object roughly the size and shape of a small segment of orange peel, and when it is in place the skin and fat simply drape over it.
Two materials dominate practice. Solid silicone is smooth and inert, does not allow tissue to grow into it, and forms a thin capsule around itself, which means it can be removed or exchanged easily years later. Porous polyethylene, sold under trade names familiar to most facial surgeons, has an open structure that tissue grows into, anchoring the implant firmly to the bone; the trade-off is that removing it later is considerably more difficult because it has become integrated. Neither material is better in the abstract. Surgeons who prioritise reversibility choose silicone; those who prioritise absolute stability choose porous polyethylene. Because reversibility is one of the strongest arguments for choosing an implant at all, it is a reasonable question to raise before the material is decided.
Shape matters more than material, and it is decided by what is actually deficient. A malar implant sits over the body of the cheekbone and increases its projection and width, which is what creates visible skeletal definition; it is the right shape for a face that has always been flat across the midface. A submalar implant sits below the bone, filling the hollow that develops in thin or ageing faces without touching the width of the cheekbone; it is the right shape for a face that looks gaunt rather than flat. A combined shell implant covers both zones for a face that is both. Choosing the wrong zone produces a result that is technically well executed and aesthetically wrong, which is why the examination at consultation matters more than any part of the operation.
The operation itself is short and, for a surgeon who does it regularly, straightforward. Under general anaesthesia or sedation, an incision of about 1 to 2 centimetres is made inside the upper lip above the teeth. The surgeon lifts the soft tissue directly off the bone to create a pocket of the exact size of the implant, working carefully around the infraorbital nerve, which emerges from the bone just above the pocket and supplies sensation to the cheek, the side of the nose and the upper lip. The implant is placed, checked against the marks made before surgery, and in most modern practice fixed to the bone with one or two small titanium screws. The wound is closed with dissolving sutures. The whole procedure takes 45 to 90 minutes.
Screw fixation deserves a paragraph of its own, because it changed the reputation of this operation. Historically, implants were placed into a pocket and left to be held by the pocket alone, and the commonest reason for revision was an implant that had rotated or drifted a few millimetres during healing, moving the high point of the cheek and creating asymmetry. Fixing the implant to bone removes that failure mode almost entirely. The screws are permanent, cause no symptoms, do not interfere with dental treatment or imaging, and do not trigger airport security. Asking directly whether the surgeon fixes implants is one of the more useful questions a patient can put.
Recovery is dominated by the mouth rather than the face. Because the pocket is opened into the oral cavity, the first week involves soft food, antiseptic rinses after everything you eat or drink, and a course of antibiotics. Patients consistently describe this as awkward rather than painful, and most stop painkillers within 3 or 4 days. The midface swells generously and unevenly, which makes early symmetry impossible to judge, and the cheek and upper lip feel numb, which is expected and recovers over 6 to 12 weeks as the retracted nerve settles.
The honest risks divide into the medical and the aesthetic, and they are not equally likely. Infection around an implant is uncommon but consequential: an established infection generally means removing the implant, allowing 3 to 6 months of healing, and replacing it, which is why the intraoral route is covered by antibiotics and why active gum disease must be treated first. Permanent injury to the infraorbital nerve is rare but not reversible. Against these, the complications that actually generate most revision surgery are aesthetic and were decided in the theatre rather than during healing: an implant that is too large, placed too high, or whose edge can be felt through thin skin.
Which brings the discussion back to size. The single most common regret after cheek implants is that they are too big, and it is a predictable consequence of how the decision is usually made. Patients arrive with photographs of faces they admire, and surgeons are asked to reproduce a look rather than correct a deficiency. Cheek implants change projection by a few millimetres; that is enough to alter how light falls across the face and how the midface reads in a photograph, and it is also enough that a few millimetres too much is obvious. The practical safeguard is to hold the actual implant before agreeing to it. Its physical size in your hand is far more informative than a measurement or a computer simulation, and patients who do this routinely choose something smaller than they had imagined.
Surgeons look for these points at the consultation.
Cheek implants suit adults with flat, low or poorly defined cheekbones, a hollow submalar midface, or skeletal asymmetry, who have healthy teeth and gums, are not smoking, have realistic expectations about a change measured in millimetres, and who want a permanent result rather than repeated filler appointments.
Reasons a good surgeon will ask you to wait or choose something else.
Cheek implants are avoided in active dental, gum or sinus infection, uncontrolled diabetes or immunosuppression, current smoking that cannot be stopped for 4 weeks either side of surgery, previous radiotherapy to the face, body dysmorphic disorder, and in patients whose facial skeleton has not finished growing.
Ask your surgeon which technique they recommend for you and why.
The implant is placed over the body of the cheekbone to increase its projection and width. This is the shape chosen when the aim is definition and a higher, more prominent cheekbone.
The implant sits below the cheekbone in the hollow of the midface, filling the gaunt area that develops with age or weight loss without changing the width of the cheekbone itself.
A single implant covers both the cheekbone and the hollow beneath it, used where the midface is both flat and hollow. It is the largest of the standard shapes and needs the most careful sizing.
A three-dimensional CT scan of the facial skeleton is used to design an implant that matches the patient’s own bone exactly, then manufactured individually. Used in marked asymmetry and in revision cases.
Step by step, from arrival to discharge.
Before cheek implants are placed the surgeon marks the intended high point with you sitting upright, and selects the implant shape by zone: over the bone, below it, or both.
General anaesthesia or sedation is given, together with intravenous antibiotics, because the pocket will be opened into the mouth.
A 1 to 2 centimetre incision is made inside the upper lip above the teeth, leaving a cuff of tissue for closure and keeping the wound away from the implant edge.
The soft tissue is lifted directly off the bone to a pocket matched to the implant, with the infraorbital nerve identified and protected throughout.
The implant is seated against the marks and fixed to the bone with one or two titanium screws so it cannot rotate or drift while the pocket heals.
Both sides are compared with the head in a neutral position before the intraoral incisions are closed with dissolving sutures.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
The risks of cheek implants divide cleanly into two groups, and patients tend to worry about the wrong one. Infection and nerve injury are the medically serious complications, and both are uncommon: prophylactic antibiotics, a clean intraoral technique and careful retraction of the infraorbital nerve keep them that way.
The complications that actually generate revision surgery are aesthetic and mechanical: an implant that is too big, placed too high, or left unfixed so that it moves. All three are decisions made in the operating theatre rather than accidents of healing. This is why the questions worth asking are about sizing, about screw fixation and about how many cheek implants the surgeon places each year, rather than about infection rates.
The midface swells markedly for 7 to 10 days after cheek implants are placed, and the two sides rarely swell equally, which makes early symmetry impossible to judge.
The infraorbital nerve is retracted to create the pocket. Numbness is expected and recovers over 6 to 12 weeks in most patients; a small permanent patch of altered sensation is possible.
In a very thin face the border of the implant can be felt, and occasionally seen when smiling. Correct sizing and placement deep on bone prevent it; a visible edge is corrected by exchange.
An unfixed implant can migrate within its pocket during healing, moving the high point of the cheek. Screw fixation has made this considerably less common than it once was.
The intraoral route passes through a contaminated field, so prophylactic antibiotics are routine. An established infection around cheek implants generally means removal, a healing interval of 3 to 6 months, then replacement.
Long-term pressure can cause the bone beneath an implant to remodel slightly. It is usually of no consequence and is detected only on imaging, but it is a reason surgeons avoid oversized implants.
Permanent numbness of the cheek, side of the nose and upper lip following cheek implant surgery. It is uncommon but not reversible, and is the most important thing to weigh against a purely aesthetic gain.
Recovery from cheek implants is dominated by the mouth rather than by the face. Because the implants go in through the upper lip, the first week is about soft food, mouth rinses and limited jaw opening, and most patients describe it as awkward rather than painful. Regular paracetamol is usually enough after the first 2 days.
The honest timetable is 1 week before you would meet a stranger, 3 weeks before you would be photographed, and 3 months before the shape you paid for is the shape you see. Numbness of the cheek and upper lip is part of the normal course and unsettles people who were not warned; it recovers gradually over 6 to 12 weeks.
Days 1-3
Expect a tight, full midface and difficulty with wide mouth opening. Cold compresses for 48 hours, head elevated, antiseptic mouth rinses after every meal and nothing harder than soft food.
Days 4-7
The worst is over by day 4. Bruising tracks down towards the jaw as it fades. The surgeon checks the pocket and the implant position before clearing you to fly, usually around day 5.
Weeks 2-3
Intraoral sutures dissolve and eating becomes comfortable. Office work and light exercise resume. Residual swelling remains obvious to you and unnoticeable to others.
Weeks 4-6
The true position of the cheek implants emerges as swelling resolves. Cheek and lip numbness is recovering. Full exercise, contact sport still avoided.
Month 3
The implant is fully encapsulated and the result is settled. Symmetry can now be assessed honestly, and any exchange or repositioning is planned from this point.
A good result from cheek implants is recognised as better bone structure rather than as surgery. The high point of the face moves up and out by a few millimetres, the midface catches light differently, and photographs taken from an angle stop looking flat. Patients frequently report that people ask whether they have lost weight or been on holiday.
The result is not visible for some time. The midface swells substantially for the first fortnight, settles slowly over 6 weeks and reaches its final shape at around 3 months. Judging symmetry before that is unreliable, because the two sides rarely swell equally, and surgeons will decline to discuss revision until the 3 month point for exactly that reason.
Longevity is the strongest argument for implants over the alternatives. Cheek implants do not degrade, resorb or need replacing, and most patients keep the same implants for life. The projection created on the day of surgery is the projection present decades later. What changes around them is the soft tissue: the skin thins and the midface continues to descend with age, so an implant placed at 35 sits in a different face at 60, generally still reading well because the underlying proportion was improved.
Reversibility is the second argument, and it is underappreciated. Because a capsule forms around a smooth silicone implant, removal is a shorter operation than placement and the face returns close to its original appearance. Knowing that an unsatisfactory result can be undone changes the risk of the decision substantially, and it is a real difference from fat transfer, which cannot be selectively removed once it has taken.
Cheek implants are priced as an operation plus a device, and both parts vary. The surgical fee reflects theatre time, the anaesthetist and the surgeon; the device fee is modest for a standard off-the-shelf implant and several times higher for a custom implant designed from a CT scan, which also adds the scan itself and several weeks of lead time.
The cost of combining matters more here than in most facial surgery. Because cheek implants take under an hour and share an anaesthetic, adding them to a facelift, rhinoplasty or eyelid operation costs far less than booking them separately, and surgeons will normally quote the combination rather than the sum of two independent procedures.
Before comparing totals, check what is included: the implant itself, the anaesthetist, day-case theatre, follow-up appointments, and what happens if the implant has to be repositioned or exchanged. A revision policy that covers the device but not the theatre is not a revision policy in any meaningful sense.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
Adds soft volume using your own tissue and improves skin quality, but cannot create the defined projection an implant gives over bone.
Temporary, reversible and immediate, and the most reliable way to preview an implant before committing to surgery.
The wider comparison of every method of adding midface volume, including when not to operate at all.
Where the midface has fallen rather than flattened, repositioning tissue treats the cause rather than compensating for it.
Ask the same questions at every consultation so you can compare answers.
Cheek implants are made from solid silicone or from porous polyethylene. Solid silicone is smooth, does not integrate with tissue and can be removed easily, which is why many surgeons prefer it in the face. Porous polyethylene allows tissue to grow into the implant, which anchors it firmly but makes later removal more difficult. Neither is the silicone gel used in breast implants, and neither can leak, because both are solid materials.
Both have been in use for decades with well-documented outcomes. The choice between them is usually the surgeon’s habit and the specific shape required, rather than a safety question.
Not if they are correctly sized. Properly chosen cheek implants change facial projection by a few millimetres, which reads as better bone structure rather than as surgery. What people recognise is over-augmentation: a cheek that is too wide, too high or shelf-like, particularly when the rest of the face is thin.
Ask to hold the actual implant the surgeon proposes. Seeing the physical size of what is going into your face is far more informative than a photograph or a simulation, and it is the single best protection against an over-large result.
Yes. Removal of cheek implants is a shorter and simpler operation than placement, done through the same incision inside the mouth, and the face returns close to its original appearance because the pocket collapses. Exchange for a different size is done the same way. Porous implants that tissue has grown into are more difficult to remove than smooth silicone, which is worth discussing before choosing the material.
Cheek implants do not have a lifespan in the way breast implants do. They do not degrade, leak or require routine replacement, and most patients keep the same implants permanently. Revision, when it happens, is because the aesthetic preference changed, because of malposition, or because of infection, and not because the implant wore out.
Neither is better; they do different jobs. Cheek implants add projection over bone, which is what creates definition, and the result is permanent and predictable. Fat transfer adds soft volume and improves skin quality, but an unpredictable proportion is absorbed and it cannot build a defined cheekbone. Many surgeons use both in the same patient, placing an implant for structure and fat around it to soften the transition.
Plan on 5 days as a minimum after cheek implants are placed. The purpose of the wait is a wound check inside the mouth and confirmation that there is no bleeding into the implant pocket, both of which are far easier to deal with before you leave. Take soft food for the flight, keep rinsing after meals, and expect swelling to look temporarily worse in the cabin.
Most surgeons now fix cheek implants to the bone with one or two small titanium screws, and it is a reasonable question to ask directly. Fixation prevents the implant rotating or drifting within its pocket during healing, which was historically the commonest reason for revision. The screws are permanent, cause no symptoms and do not set off airport security.
Cheek implants themselves are not metal and do not trigger airport scanners, and neither do the small titanium screws used to fix them. On a dental or facial X-ray, a porous polyethylene implant is essentially invisible while solid silicone shows faintly, and the fixation screws are clearly visible. It is sensible to mention facial implants before an MRI or a CT scan, not because they are unsafe, but so the radiologist is not puzzled by what they see.
You can usually feel that the cheekbone is firmer, particularly in the first months while the tissue is still tight over a new implant, but a correctly sized implant placed deep on bone should not have a detectable edge. In a very thin face the border can sometimes be felt at the outer margin, and occasionally seen when smiling broadly, which is a sizing and placement issue rather than a normal finding.
What patients notice far more than the implant is the numbness. The cheek, side of the nose and upper lip feel dulled for 6 to 12 weeks while the infraorbital nerve recovers, and during that time the face feels unfamiliar in a way that has nothing to do with the implant itself.
Make-up can be used on the skin as soon as there is no wound on the face, which after intraoral cheek implant surgery is immediately, though swelling makes it of limited use for the first week. Light cardiovascular exercise is usually allowed at 2 weeks and full training at 4 weeks.
The restriction that lasts longest is on anything that might strike the face. Contact sport, racket sports and martial arts are avoided for 6 weeks, until the implant is fully encapsulated and the fixation is supported by healed tissue.
An established infection around cheek implants almost always means the implant has to be removed, because bacteria form a film on the surface that antibiotics cannot reliably clear. The implant is taken out through the same intraoral incision, antibiotics are given, and the face is allowed to settle for 3 to 6 months before a replacement is considered. The great majority of patients who go through this do end up with implants successfully at the second attempt.
Early signs are worth knowing because early treatment occasionally saves an implant: increasing rather than decreasing pain after the first few days, spreading redness over the cheek, fever, a bad taste in the mouth, or discharge from the intraoral wound. Any of these warrants contacting the surgeon the same day rather than waiting for a scheduled appointment.
Yes, but the filler changes both the assessment and the timing, so it has to be declared. Hyaluronic acid placed over the cheekbone makes it difficult for a surgeon to judge how much of your current shape is bone and how much is product, and planning an implant against a temporarily inflated face is how patients end up over-augmented. Some surgeons will dissolve the filler with hyaluronidase and reassess a few weeks later before deciding on a size.
Long-standing filler matters more than recent filler. Products described as permanent or semi-permanent, and repeated hyaluronic acid over many years, can leave firm tissue that alters the plane the implant pocket is made in and slightly raises the infection risk. Tell the surgeon what was used and when, even if you are not certain of the product name, because a rough history is far more useful than none.
Wait until 3 months, then look at three things rather than at the mirror generally. First, where the high point of the cheek sits: it should be just outside and below the outer corner of the eye, not out towards the ear and not down on the mid-cheek. Second, whether the transition onto the lower eyelid and down to the mouth is smooth, with no step or ridge you can see in raking light. Third, whether the two sides match closely in position, accepting that no face was symmetrical to begin with.
Photographs are more reliable than mirrors for all three, particularly photographs taken from a 45 degree angle, which is where cheek implants show most clearly. Comparing them with your own pre-operative photographs taken at the same angle and in the same light is the only fair assessment.
American Society of Plastic Surgeons2024Professional society
NHS2024Regulator
Mayo Clinic2024Other
Consultation request
Tell us the procedure and destination you are considering. We forward your request to the verified clinic you select.