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Cheek Implant Revision city, state

young woman Many patients seek a change to the shape or volume of their upper cheek area (“cheekbone”, also known as the zygoma or malar eminence), alone or in combination with other aesthetic enhancements such as blepharoplasty (eyelid lift) or rhytidectomy (facelift or neck lift). In most cases, the desired procedure is cheek augmentation (enlargement). Revision cheek implant surgery (removal or replacement) is the procedure to correct or change the results of a prior cheek implant surgery. When cheek implant placement is unsatisfactory, the problem can be fixed. Dr. Ransom specializes in cheek implant revision surgery.

The most common reason that patients seek secondary cheek implant surgery is improper position or placement of the implant, or migration of the implant after surgery. Cheek implants may be placed via an incision inside the mouth, between the gums and the upper lip and cheek, or via a lower eyelid incision.

This choice is made based on the size of the implant and whether other surgical procedures are being performed concurrently. The trans-oral approach (incision in the mouth) sometimes results in placement of the implant too low in the cheek. This can give the patient an unnatural fullness next to the nose and upper lip, which is particularly obvious when speaking or making facial expressions.

The trans-blepharoplasty approach (incision in the lower eyelid) can result in implant placement too high in the cheek. This makes the lower eyelid appear full and may change the apparent shape of the eye, particularly when smiling. In addition, scar formation around an implant placed through this approach can tether the lower eyelid to the cheek bone, causing difficulty with closure of the eye (lagophthalmos or ectropion) or an increase in the amount of the white of the eye (sclera) which is visible (scleral show).

The second most common reason patients decide to revise a cheek implant is that they do not like the size or shape of the implant selected by another surgeon.  Modern cheek implants come in many sizes and shapes and can vary in design to include only the upper cheek (malar region) or the upper and middle cheek (malar and submalar regions).

Another variety of implant sits directly on the orbital rim (eye socket), and provides volume enhancement in the region of the lower eyelid. Indications for implant placement in this area are rare. Selection of the proper type and size of cheek implant requires a detailed conversation with the surgeon, including analysis of patient photographs or computer-enhanced imaging. Dr. Ransom always dedicates a significant amount of time to this pre-operative discussion, as he believes it is crucial to a successful aesthetic outcome.

Finally, there are rare cases where the primary cheek implant has become infected and must be removed. An acute infection should be dealt with by the surgeon who placed the implant; however, in some patients infection manifests as a latent or indolent phenomenon and may be related to the presence of a biofilm. Biofilms are bacterial infections that form on mucosal surfaces or foreign bodies, and have been described in all types of cosmetic implant surgery and even with soft tissue fillers. It is often necessary to remove the implant when a biofilm is suspected. The patient must then allow the area to “cool off” with antibiotics for a few weeks before considering revision implant surgery (replacement).

Sometimes patients decide that they do not want no cheek augmentation at all.  In these cases the cheek implant is removed via the same incision as it was placed, and the incision for access is then meticulously closed or revised as needed.  With the implant removed, the patient’s face generally returns to its pre-operative appearance.  If the implant that was removed was very large, it is possible that the underlying maxilla (upper jaw bone) will be remodeled (flattened or thinned) or the overlying skin stretched and loose. In these cases Dr. Ransom offers the patient autologous fat grafting to fill in the facial volume deficiencies and scar revision to remove excess skin whenever possible. These procedures are typically undertaken after adequate healing from the implant removal has occurred, to better assess the contour abnormalities and to allow the wound to contract.

Revision cheek implant surgery can be performed under light sedation, and may accompany other cosmetic or reconstructive procedures. Cheek implants can be an excellent complement to blepharoplasty (eyelid lift) or face and neck lift surgery. With subtle increases in the projection of the malar region or changes in the shape and contour of the cheeks, significant improvements in the harmony between facial areas can be achieved. Dr. Ransom and his patients select from the most up-to-date implant designs to provide a modern aesthetic augmentation, avoiding extreme changes or unnatural shapes. He uses only biocompatible Silastic (silicone-based) implants, which have the lowest rate of complications of all the available materials.

Who is a candidate?

Anyone who has had cheek implants placed but is unsatisfied with the result or has had complications may be a candidate for cheek implant removal or revision. Cheek implant removal or revision may be a stand-alone procedure, or can be combined with other aesthetic or reconstructive surgeries.

The key to any facial implant surgery is identifying the most appropriate size and shape of the implant – to achieve the greatest aesthetic enhancement, while still looking natural. Dr. Ransom understands that even well-placed implants do not always give the desired effect. More information about placement and removal or revision of facial implants is available during your consultation.

Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.

Our Patient Reviews

San Francisco Center for Facial Plastic, Reconstructive & Laser Surgery

5 / 5.0

Based on 23 reviews

Christina G.

I had several nasal/sinus issues including a severely deviated septum and a dorsal hump, which I wasn't crazy about. Dr Ransom did both the medical and aesthetic parts of my surgery and he did a wonderful job! While I did have some swelling, I didn't experience much bruising at all. I loved that he left the natural look of my nose just making small corrections. My breathing has GREATLY improved. His office staff was super helpful in scheduling and making sure payment and everything was very clear. I am very, very, very pleased with my results!!

Tk I.

I had a terrible surf accident in Bali and needed to get 50 stitches to repair what the reef did to my face. I had emergency cosmetic surgery in Bali the day of the accident. Immediately when i got back to the states i was introduced to Dr Ransom through some mutual friends. I was searching for the best cosmetic surgeon in San Francisco to help in my recovery. He and his team have been amazing! he helped establish a plan for my post-op wound care/treatment and administered some initial laser treatments. Dr Ransom and his team are extremely knowledgeable and very patient / helpful. I am very grateful for their help and support. I am finally looking normal again!

Joey B.

I had three issues with my nose - which inhibited my breathing: 1- broken nose, 2 - narrow nostrils that collapsed when I inhaled through my nose, 3 - deviated septum. When I was living in New York, I went to see a doctor about my breathing issues, and he said my skin was too thin and there was likely nothing he could do to rectify the problem. Dr. Ransom was recommended by an ENT I saw through One Medical. As soon as he saw him, he said he could easily fix my nose, and remove the bump that had formed from the trauma. His confidence and strong sense of self immediately put me at ease, and I had little doubt that he could accomplish exactly what he promised. He showed me a modified picture of my nose , and really liked what he proposed. The end result very closely matched what he promised. Not only can I now breath much more easily through my nose, it looks much better. He managed to make it look like an improved version of itself, however I still look like me, and unless I tell anyone I had it done, it's not overly noticeable, which I prefer. I'm pretty vain and very critical, and I can say that Dr. Ransom is great, and comes highly recommended.

Edward T.

Doctor Evan Ransom took my surgery on relatively short order and did a wonderful job. He is very talented and has a nice friendly professional support staff. I can not thank him enough, he was calm, caring, professional and interested in the follow results of his work . He seemed to bring a certain artistry to the profession.

Lisa C.

Dr. Ransom is a talented physician. He is knowledgeable, professional and goes the extra mile to make you feel comfortable during your treatments. He has been blessed with an artistic eye which brings wonderful results. I highly recommend Dr. Ransom and would refer all of my friends and family members to choose him as their physician.

Cheryl H.

Dr Ransom is very kind, honest, and conscience doctor. I was referred by my best friend, she is also Doctor Ransom patient. She has so much good things said about Doctor Ransom. So I had a face lift done by Doctor Ransom on July 2015. He did a wonderful job on my face and I have a lot of compliments on my face. So if anyone want to get their face done. I would highly recommended Doctor Ransom to you. I give Doctor Ransom a five stars.

Jill P.

I have currently been getting botox regularly with Dr. Ransom and he does a fantastic job. My previous doctor's office moved to another location where it was no longer convenient. I didn't realize what I was missing until I went to Dr. Ransom. I felt really comfortable, but most important he did a terrific job blowing my previous doctor out of the park. (Sometimes it's good switch it up a bit to make sure you are getting the best treatment.) On top of that, Dee the office manager is an incredible asset to the office. She personalizes your visit and relationship with the office to an extent I have never experienced before. I even get follow up calls to see how I am doing after a treatment. I highly recommend Dr. Ransom for his great work, and his team's impeccable customer service.

Arielle C.

Dr. Ransom and Dee are the BEST! Whether it's aesthetic or reconstructive, I'd trust him over and over again with my face.