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Facial Feminization Surgery: Cheek Augmentation

A common effect of an estrogen-dominant puberty is that the cheekbones sit higher and appear more prominently on the face than is the case for a testosterone-dominant puberty. Cheek augmentations can help make the appearance of cheekbones and/or cheek fat more prominent and give the face more of a heart shape. There are three techniques that we use at the GCC to help achieve a cheek augmentation: fillers, fat transfers and silicone implants. Below, we describe why patients might choose each procedure–from surgical invasiveness to permanence–as well as the recovery processes involved. 

Cheek Augmentation: Fillers

Another way that our surgeons can enhance the cheek bones is through the injection of filler. There are a variety of different available types of filler, with each staying in the body a different amount of time (ranging from 6 months to two years). When fillers are used to augment the cheeks, patients are not required to adhere to any activity limitations. Fillers are also an outpatient procedure, meaning if patients just want cheek fillers these can be placed in the office without any need for anesthesia. This option is less permanent than fat transfers because the fillers will be absorbed into the body over time, but some patients prefer this method in order to avoid surgery or anesthesia. Some patients use temporary filler to determine if they would like augmented cheek bones prior to undergoing fat transfer or implants–more permanent changes–to the face. In general, filler is less expensive than fat transfer because the patient will not need to pay for the operating room or anesthesia associated with fat transfer. However, with repeated filler injection, there might not be any cost savings.

Cheek Augmentation: Fat Transfers

With fat transfers, our surgeons take fat from other parts of the body and deposit it into the cheeks. This option for cheek augmentations yields the most permanent results. Usually with this procedure about 50-60% of the transplanted fat will survive the transplant. A patient can try to optimize their chances of good fat survival by avoiding strenuous activity for 4 weeks following this procedure. Avoiding strenuous exercise helps to create conditions that are more suitable for fat transfers to survive where they are transferred rather than be absorbed back into the body. In some patients, multiple rounds of fat filling is performed in order to achieve the desired result.

Cheek Augmentation: Silicone Implants

Another permanent option for patients seeking cheek augmentations are silicone implants. Silicone cheek implants are surgically attached with sutures or a screw or sutures to the patient’s zygoma or cheekbone. Implants can be placed on the malar area to increase the volume of the apples of the cheeks or the submalar area to create a rejuvenating or anti-aging effect. 

To insert the implants, two incisions are made inside the mouth, above the upper gums. As a result, scarring for this procedure is completely invisible, just like the other two approaches to cheek augmentation that we offer. Unlike fat transfers, the insertion of a silicone implant is completely reversible. That said, we do advise patients that this procedure holds a few more risks than a fat transfer, such as malposition, infection, or fluid collection around the implant. 

Facial Feminization Cheek Augmentation Recovery

Cheek augmentation recovery depends on the method of augmentation. As stated above, it is not associated with any long term activity or lifestyle restrictions when performed alone, and therefore is sometimes preferred over fat transfers or silicone implants for this reason.

On the other hand, when the fat transfer method is used, our practice recommends that patients restrict strenuous activity for 4 weeks to help support their healing and the survival of the fat in its new location.

Lastly, for silicone cheek implants, our practice asks patients to maintain a soft food diet for two weeks post-operation. Since the incisions are inside of the mouth, sharp or hard foods can break stitches before they naturally absorb into the body, aggravating the area and potentially. Likewise, it is common for patients to feel some initial pain and discomfort from the screws or sutures, which should subside in the first few weeks of recovery.