One of the most notable signs of an aging face is the loss of volume in the midface, or the area of the cheek below the lower eyelid. With time, the malar (cheek) fat pad shrinks in size and descends into the lower portion of the cheek. This, in turn, creates a line or valley in the midface. It is this loss of volume that adds considerable age to the face, and the submalar or midface implant is designed to restore volume to this area. By three-dimensionally adding volume, youth is restored to the face. The implants are permanent, yet 100% reversible at any time.
Malar and Submalar Implants
Cheek implants come in a variety of shapes and sizes and can be custom shaped to augment weak facial structure and combat the effects of aging to remove a gaunt appearance. There are also many different types of implant materials that can be used—from synthetic silicone, rigid polyethylene that needs to be screwed into place, and a synthetic material called ePTFE (a white rubbery material molded for medical use).
Cheek implants that are made of hydroxyapatite can integrate with natural bone tissue in the face and therefore become part of the cheek structure, while cheek implants that are made from silicone can be removed at a later date because they don’t integrate with the facial tissue.
There are three general shapes to cheek implants: malar, submalar, and combined.
. Malar—are meant to correct a deficiency of the cheekbone itself by placing the implant directly on the cheekbones. Augmentation of this area gives the patient higher-arched cheekbones and a more attractive facial profile.
. Submalar—are meant to correct a deficiency of the fleshy portion of the cheek and are placed directly below the most prominent portion of the cheekbone. By filling this area, the cheeks are restored a fullness that eliminates the sunken look that is associated with age and illness.
. Combined—corrects deficiencies of both the cheekbone and the fleshy portion below the cheekbone.
While cheek implants come in various shapes and sizes, most can be custom shaped to a particular facial structure.
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Who Is a Good Candidate for A Submalar Implant?
The best candidate for a submalar implant is a patient who has lost volume in the midface or cheek area. This is seen with the normal aging process and in patients who have had significant weight loss, such as with gastric bypass patients. Nearly all patients undergoing facelift surgery can benefit from the addition of submalar implants to three-dimensionally restore volume to the face.
The Submalar Implant Procedure
Most submalar implant surgeries are performed on an outpatient basis and take between 30 minutes and an hour to complete. Your doctor might also perform the submalar implant procedures with deep twilight sleep, which is a combination of local anesthesia and intravenous sedation. With this form of anesthesia, patients do not remember anything from surgery nor do they feel any discomfort. They also feel more alert and refreshed after surgery. All patients must make sure to have a board-certified anesthesiologist present at all times to monitor their vitals before, during and after surgery.
There are various approaches to the placement of submalar implants. The intraoral approach is the most common and preferred route for placing these implants and involves a small 1 – 2 cm incision made in the gingival buccal sulcus (gum line) underneath the upper lip. Once the incision is made, a special elevator is used to create a pocket on the bone overlying the midface and cheek area. Once the pocket has been created, submalar sizors are placed to determine the correct shape and size of the implant. The permanent implants are then opened, soaked in antibiotic solution, and placed within the pocket and secured to the malar (cheek) bone with a tiny 4mm titanium microscrew. The intraoral incision is closed with dissolvable sutures.
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Recovery After a Submalar Implant
Recovery after a submalar implant procedure is very quick. Most patients feel fine the next day, experiencing little to no discomfort. Patients may experience minor bruising, though there is often no external bruising due to the fact that the implant is placed through an inside or intraoral incision. The stitches need not be removed as they will dissolve on their own. Most patients are able to return to work within seven days, and some as early as a few days after surgery. But they are advised to wait 2 weeks before returning to heavy strenuous activity or exercise. As with most facial plastic procedures, complications are fortunately very rare. Some potential complications may include infection, extrusion, numbness of the upper lip, hematoma and asymmetry.