This surgery utilizes different types and sizes of cheekbone implants to prop up the midface depression, and the materials of prostheses include silicone implant, Sili-Tex implant, and Medpor, which should be selected in light of the severity of individual depression and surgical requirements. Generally, for mild to moderate midface depression or for pure esthetic purposes, Dr. Chuang recommends the use of silicone or Sili-Tex implant because it is convenient for emplacement and easy to maintain and remove. There are various styles and sizes for physicians to select according to individual bone structures and subjective requirements. Because these prostheses can be easily emplaced without any screw fixation, the postoperative recovery is fast. However, if a congenital cheekbone variation or trauma causes large-area depression or incurs a bone deformity, structural repair materials such as Medpor should be employed for the reconstruction and correction of the midface defect to attain complete and radical improvement.
The surgical incision varies along with the type of implant. Concerning silicone malar/sub-malar implants or Sili-Tex cheekbone implants, the incision is made at the upper gingiva inside the mouth. Dr. Chuang first makes a 1.5–2-cm incision at the upper gingiva on both sides, dissects the proper subperiosteal pocket, and emplaces the pruned silicone or Sili-Tex implants into the depressed cheekbone area to make the implants attach tightly to the bone, which would become fully stable and fixed after 1 month. Regarding Medpor, an additional incision needs to be made at the lower eyelid to perform larger-area subperiosteal detachment via the two incisions before the emplacement of Medpor. To secure the implant position, Medpor needs to be fixated with titanium screws to prevent future displacement. Regardless of the emplacement of either prosthesis, it is targeted to fill from the deepest layer of the structure, and the midface skin would also become tight or partially lifted, so it can offer regional improvement of the depression at the tear-trough groove or nasolabial folds and is less likely to incur facial muscle load or future droopiness, like that observed with the injection of hyaluronic acid or fats. Therefore, this surgery is also suitable for patients with submalar triangle droopiness due to facial skin looseness or collagen loss.