This surgery is also called “apple cheek augmentation” and mainly improves midface deficiency from the lower margin of the orbital bone (tear-trough groove) to the upper margin of the nasolabial fold, with the lateral scope not beyond the border line of the junction of zygomatic body and arch. Submalar triangle depression or broken shadows (also called Indian marks) are mainly ascribed to a congenitally broad cheekbone, an excessively prominent upper palate (maxilla), a dental malocclusion, a deep bite or pre-malar skin droopiness due to aging. Mild symptoms make the tear-trough groove and nasolabial folds more obvious, leaving the impression of being tired or having aged, while severe symptoms present with the sinking of the lateral side of the cheek, thus rendering the cheekbone or upper palate more prominent and a crescent-shaped face (also called a machete face). Such a large-area midface depression is difficult to be only redressed by a non-surgical filler or fat injection and generally needs abundant filling volume to restore the normal appearance.
This surgery mainly aims to restore the plumpness and fullness of the middle one-third region of the face to enable the skin of both cheeks to naturally lift and bulge and present a round shape like an apple, thus giving it the name “apple cheek augmentation.” Therefore, such a depression is attributable to only cheekbone (hard structure) deficiency or simultaneously soft tissue loss, so the following two methods are available for the surgery: