Cheek implants or fat grafting? Alternate injectibles?

Is there a general consensus on which to choose? Should it impact the surgeon one chooses?

For example, have received several quotes & each surgeon typically only does implants or injections.
While one will tout that implants are maintenance free, another will tout how much more precise they can be with fat grafting. I realize there are surgeons who will do either or, tho they seem few & far between.

Costs would appear to be similar if you are already in for FFS. Was just curious if there was a general consensus among the members here for which to choose?

My FFS surgeon told me that nothing feminizes your faced better than cheek implants. The implants are similar to a female high cheek bone contour. Where the fat grafting is more similar to a young woman's cheeks. I am 68 years old and many women my age just do not have much facial padding at all.

You did not mention your age or how long you have been on HRT. These are both important factors on which would be the best method for you. We all have different bone structures and facial padding. Your surgeon should be able to tell you what is best for you.

For myself, I decided not to do any cheek work because I have a few hobbies that I feel that high cheek bones would be problematic. I scuba dive and the fit of the mask to my face is important. I also shoot shotgun sports, such as trap and skeet and the recoil will impact on my cheek bone. And besides, how many 68 year old ladies really look like they are 20? Yes, it can be done, but not for me, thank you.

All of my fat injections failed that I had with FFS. I would not do it again. 

Am so sorry Rachel & that is the exact same thing I worry about happening with me as well. Am also not the type that would travel back to have it redone multiple times. So am leaning toward implants.

I had fat grafting which failed and I had full facial bioplasty with permanent fillers. I am very happy with the results. I am not sure about implants though

My fat transfer failed to take and traveled to an area under my eye. I blame the skill (lack of) of the surgeon. I will not repeat. I have been warned against shifting implants. Who knows.
Moni

I may comment on some things?

First of all, high cheek bones are not really a gender marker in themselves - as can be seen by looking to Korea where women get their high cheek bones reduced to be more feminine. It is more a thing of beautification. However, high or strong cheekbones contribute to a more "stretched" facial skin and tissue. This makes for a more youthful appearance even with some age.

Regarding the choice of method - I am not sure whatreborn means with "permanent fillers" - so far I only know of silicone as a permanent filler and that is usually a bad idea. Other fillers eventually will be going away. Fat transfer is a bit of a game of luck - maybe it catches, maybe it does not - between 0 and 80% of the fat can stay in the long run - if it is 0 or 80 depends on the body, hormones, the skill of the surgeon and the technique. What should be impossible with fat grafting though is that the fat "moves" as Moni said - this is because it is not the fat that is transferred, but the cells who store fat. They should not be able to travel. However some surgeons probaby destroy a lot of the fat cells, liberating the fat/oil from them and the oil can travel, of course - this is quite a bad complication though, it should not happen with a skilled surgeon. Implants are probably the best choice in terms of how well it can be planned and for long term stability - they will never go away and if they are of the type that is fixed to the bone, they also will not move. But of course its an implant - a foreign material in the body and can cause reactions of the body. Also there has to be an incision and the place for the implant has to be opened surgically, which can cause complications like problems with healing of the wound inside the mouth.

My personal preferrence would probably be fat grafts, done by a skilled surgeon, maybe do it 3 times to build up enough cells that really stay. But that is for me personally as I hat implants generally and because I already have strong and high cheekbones naturally. If I would not have them, I might very well choose implants.

I am also scuba diving by the way and I dont know if my cheekbones make a difference there - if one finds a mask that fits, it should be ok. I am more worried about the future of my diving when it comes to the forehead surgery and the changes of the frontal sinus...

Quote from: anjaq on October 25, 2017, 05:53:21 AM
I may comment on some things?



Regarding the choice of method - I am not sure whatreborn means with "permanent fillers" - so far I only know of silicone as a permanent filler and that is usually a bad idea. Other fillers eventually will be going away. Fat transfer is a bit of a game of luck - maybe it catches, maybe it does not - between 0 and 80% of the fat can stay in the long run - if it is 0 or 80 depends on the body, hormones, the skill of the surgeon and the technique. What should be impossible with fat grafting though is that the fat "moves" as Moni said - this is because it is not the fat that is transferred, but the cells who store fat. They should not be able to travel. However some surgeons probaby destroy a lot of the fat cells, liberating the fat/oil from them and the oil can travel, of course - this is quite a bad complication though, it should not happen with a skilled surgeon. Implants are probably the best choice in terms of how well it can be planned and for long term stability - they will never go away and if they are of the type that is fixed to the bone, they also will not move. But of course its an implant - a foreign material in the body and can cause reactions of the body. Also there has to be an incision and the place for the implant has to be opened surgically, which can cause complications like problems with healing of the wound inside the mouth.

I  don't know the science I will admit, but I have a lump of fat in a little jar that a second surgeon removed from under my eye. It is fat.
Moni

Oh I believe you - that means that they transferred fat and not fat cells. This is highly unprofessional then. The idea is to take complete living cells which have fat in them, transfer them, they keep on living in theri new place and glue themselves together, small arteries form to supply them with blood and all is well. If they are killed in the process, the fat will leak out, but without cells the fat is not bound to a place and basically actls like silicone injections. Its sometimes called oil cysts.

Yes we are in total agreement. The surgeon was highly unprofessional in many respects.

FWIW... I'm going to chide in with Monica and others. All my facial fat implants dissolved or failed or whatever you choose to name it. I also had one under my eye that was a lump but finally just dissolved (thank god.) The others you would never have known were ever there. Very disappointing. 😟 particularly when you factor in they're not cheap. I would suggest bony work, implants and facelifts....the rest seems to be snake oil.

Silicone cheek implants are definitely more predictable in terms of the results and can be sized during surgery to determine the optimal cheek augmentation.  What you see and what you get as a final result essentially.   Fat grafting also works great but even in the greatest of hands, only 80-90% of fat grafts survive or sometimes alot less.  This could lead to some asymmetry since how much fat survives can be unpredictable.   

I typically tell patients if they want a one and done procedure without maintenance to choose cheek implants.  If having an implant is a concern, fat grafting is a great alternative but I caution that it may require several treatments to get the right amount of augmentation.  Also fat is living tissue and can grow or shrink depending on weight gain and loss. 

Most of my patients pick silicone cheek implants when presented with either option.   Silicone cheek implants are well tolerated in the body with very low infection risk and can be easily removed or exchanged.  Most of my cis gender patients after 1-2 years of fillers such as Voluma request cheek implants so they do not have to continue the 6-12 month maintenance. 


Kyle Keojampa, MD, FACS
Facial Plastic and Reconstructive Surgery
Facial Feminization Surgeon
http://www.drkeojampa.com
Los Angeles, California

What is the difference between the various cheek features anyways? So I have high and pronounced cheekbones. But still, some surgeons suggested cheek implants for me, while others said my cheeks are very well shaped and I should not touch them. I am guessing there is a difference between cheekbones, cheeks, the various places where cheek implants or fat would be added?

I had fat injected to my cheek and my temple in korea and doc say will stay there between 3-5 years. Its been almost 2 years and everything is still there.

Quote from: keojampamd on October 26, 2017, 02:06:17 PM
Silicone cheek implants are definitely more predictable in terms of the results and can be sized during surgery to determine the optimal cheek augmentation.  What you see and what you get as a final result essentially.   Fat grafting also works great but even in the greatest of hands, only 80-90% of fat grafts survive or sometimes alot less.  This could lead to some asymmetry since how much fat survives can be unpredictable.   

I typically tell patients if they want a one and done procedure without maintenance to choose cheek implants.  If having an implant is a concern, fat grafting is a great alternative but I caution that it may require several treatments to get the right amount of augmentation.  Also fat is living tissue and can grow or shrink depending on weight gain and loss. 

Most of my patients pick silicone cheek implants when presented with either option.   Silicone cheek implants are well tolerated in the body with very low infection risk and can be easily removed or exchanged.  Most of my cis gender patients after 1-2 years of fillers such as Voluma request cheek implants so they do not have to continue the 6-12 month maintenance. 


Kyle Keojampa, MD, FACS
Facial Plastic and Reconstructive Surgery
Facial Feminization Surgeon
http://www.drkeojampa.com
Los Angeles, California

Thank you Dr Keojampa. That is me, low maintenance.  Only teasing, but am not one for going back often. Also have seen some with cheeks that are over filled with fat grafting assuming they will lose X percentage. Would think it would be difficult to avoid wrinkles with aging going that route long term? Not that there is a right or wrong way for all, but think for me would rather try implants.

Quote from: anjaq on October 26, 2017, 03:49:16 PM
What is the difference between the various cheek features anyways? So I have high and pronounced cheekbones. But still, some surgeons suggested cheek implants for me, while others said my cheeks are very well shaped and I should not touch them. I am guessing there is a difference between cheekbones, cheeks, the various places where cheek implants or fat would be added?

I was told the same by a make up artist. Then followed by Dr the very next day saying my cheeks were flat. My interpretation, (which could be totally wrong btw) is that while my cheek bones are high. They have zero to little projection. So adding that slight projection forward(not in width) combined with rhinoplasty to reduce the size of the nose would give a somewhat more feminine appearance. Have read it also reduces the perceived mid face height.

I think the topic of cheeks in respect to feminization seems to be less than well studied. There seems to be a lot of opinions out there - also reflected by different assessment by different "experts" on facial features. As I said, some surgeons told me my cheekbones are perfect and admirable, others told me I should get implants.
Thre is also always the aspect of people trying to sell procedures, so they may tend to suggest things that are not needed but may be beneficial - and some less honest ones may even suggest them if they are not helpful, because they will get an extra payment for it.
I tried to get different assessment of various surgeons and found that some parts are suggested by almost all of them and I think those are the key issues. The other things seem to be very much optional and especially when it comes to implants I am a bit traumatized by the breast implant story, so I try to skip it and see how it goes. I can later still try fat grafts.

Quote from: anjaq on October 25, 2017, 05:53:21 AM
I am also scuba diving by the way and I dont know if my cheekbones make a difference there - if one finds a mask that fits, it should be ok. I am more worried about the future of my diving when it comes to the forehead surgery and the changes of the frontal sinus...

As I mentioned earlier, I also scuba dive. I had FFS with reduction of my brow ridge where my surgeon removed a section of my brow bones, reshaped them and reinserted them in the same place. My forehead is fantastic. I was diving to a deep depth at 1 month post op. It really depends on the skill of your surgeon.

It is late, or early pending perspective & have only read the summary at this point. But found the information helpful with regard to lipofill/fat grafting & may be another will as well.

"This study was performed in 45 patients (29 women and 16 men) operated between December 2012 and June 2014. All patients were affected by maxilla-mandibular asymmetry and underwent orthognatic surgery for hard tissue correction of the deformity. Residual facial alterations were then treated with lipofilling refinement proceure. In all cases good integration of the grafted fat was observed in the recipient sites. Retrospective analysis of photographic documentation showed progressive volumetric decrease for up to approximately 6 months after surgery; after that graft volume remained relatively stable. There were no significant surgical complications, either from the fat harvest site or the reconstructed site. Mild oedema and bruising were frequent during the first post-operative week. No haematomas, infections, vascular or nervous injuries were recorded. Twenty-four patients felt the need to have a second procedure. A second fat transfer was performed in 22 cases, and a third in 2 (total of 69 procedures). Based on the observations of our study, fat grafting is a simple, effective and reproducible technique, with a high satisfaction rate and few disadvantages or complications. We demonstrated that the success of lipofilling is dependent on the treated aesthetic subunits of the face. The malar and lateral cheek regions seem to be highly favourable for fat grafting, unlike the upper and lower lips subunits"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225791/