El mundo de la estética está en constante evolución, introduciendo nueva terminología que a menudo difumina las fronteras entre intervenciones quirúrgicas y no quirúrgicas. Entre los términos más buscados y malinterpretados se encuentran "implantes de pómulos" y osteotomía.” While both aim to enhance the midface, they are fundamentally different in their anatomical goals, procedural técnicas, longevity, and the facial structures they address. Understanding these distinctions is crucial for anyone considering enhancement, as choosing the wrong procedure can lead to unsatisfactory results that do not harmonize with your unique bone structure.
The confusion often stems from social media trends, where the terms are used interchangeably to describe a sculpted, defined cheekbone look popularized by models and celebrities. However, from a medical standpoint, implantes de mejillas typically involve the placement of synthetic materials to add volume to the anterior cheek, while malar osteotomy is a bone-cutting procedure that repositions the existing zygomatic arch to create lateral width and projection. This guide will dissect the clinical realities of both, comparing the surgical spectrum from implant placement to bone repositioning against the structural changes offered by osteotomy techniques.
When considering midface enhancement, choosing between adding volume with implants or creating width with osteotomy can feel overwhelming. Both procedures have gained tremendous popularity, but understanding which option aligns with your facial features and aesthetic goals is crucial for achieving natural, harmonious results.
— Perspectiva clínica del Dr. MFO
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Defining the Aesthetics: Volume vs. Width Anatomy
To understand the procedures, we must first define the anatomy of the midface. The “cheek” is composed of the zygomatic bone (cheekbone) and the underlying soft tissue fat pads. “Volume” refers to the anterior projection of the cheek—the fullness that creates a youthful, rounded appearance when viewed from the front. “Width” refers to the lateral projection of the zygomatic arch—the distance from the face’s centerline to the outermost point of the cheekbone, creating a sculpted, angular silhouette.
The structural differences dictate the surgical approach. Achieving volume often involves placing a solid implant or injecting fat onto the anterior maxilla and zygoma. Achieving width requires altering the skeletal framework itself by cutting and repositioning the zygomatic arch. Without addressing the underlying bone structure, soft tissue additions can sometimes look artificial or disproportionate, especially in patients with naturally narrow faces.
The Role of the Zygomatic Bone
The zygomatic bone is the cornerstone of midface aesthetics. It consists of the body (anterior portion) and the arch (lateral portion). In many ethnicities, the zygomatic body is underdeveloped, leading to a flat midface. To enhance this, surgeons must decide whether to augment the body (volume) or reposition the arch (width). The zygomatic bone is connected to the temporal bone via the zygomaticotemporal suture, which is the critical point for osteotomy procedures.
The difference between a subtle, rounded cheek and a sharp, angular cheekbone lies in the vector of projection. An implant procedure typically projects the cheek forward, filling the tear trough and midface hollow. A malar osteotomy projects the cheek outward and laterally, widening the face and creating a more aggressive, sculpted look. This is why osteotomy is rarely achievable with implants alone without significant anatomical compromise.
Surgical Pathways: Implant Placement and Osteotomy
Surgical midface enhancement offers the most permanent and anatomically sound results. The primary vehicle for volume is the placement of cheek implants (malar augmentation), while the primary vehicle for width is the zygomatic sandwich osteotomy (ZSO). An implant procedure typically involves creating a pocket in the soft tissue overlying the zygomatic body and inserting a silicone, polyethylene, or Gore-Tex implant.
The Zygomatic Sandwich Osteotomy (ZSO) technique creates lateral cheek width and, by that effect, makes the anterior cheek looks less prominent. (more flat)
— Eppley Plastic Surgery
The gold standard for permanent width enhancement is the Zygomatic Sandwich Osteotomy. This involves an intraoral incision to access the zygomatic bone. The cirujano cuts the bone at specific points (osteotomies) and repositions the entire zygomatic arch outward and backward. The “sandwich” refers to the technique where bone grafts may be placed between the cut segments to maintain the new position. This procedure is invasive and requires general anesthesia, but the results are permanent and address the underlying skeletal structure.
| Procedimiento | Anatomía del objetivo | Ubicación de la incisión | Anestesia | Recuperación |
| Implantes de mejillas | Zygomatic Body (Anterior) | Intraoral or Lower Eyelid | Local with Sedation | 7-10 Days (Swelling/Bruising) |
| Malar Osteotomy | Zygomatic Arch (Lateral) | Intraoral | General | 2-3 Weeks (Significant Swelling) |
| Nanofat Grafting | Soft Tissue Volume | Donor Site (Abdomen/Thigh) | Local | 3-5 Days (Minimal) |
| Reducción de mandíbula | Mandibular Angle | Intraoral | General | 2-3 Weeks (Swelling/Diet) |
Las limitaciones anatómicas de la cirugía
Not every face is suitable for a dramatic malar osteotomy. Patients with thin skin or minimal soft tissue coverage may find that repositioning the bone creates a sharp, skeletal appearance that feels unnatural. Conversely, patients with heavy soft tissue (thick skin and subcutaneous fat) may find that implants alone are insufficient to create definition, as the soft tissue drapes over the implant, masking the result.
For these anatomical reasons, Cheek Implants are often considered a safer choice for faces that lack significant soft tissue thickness. They add volume without altering the facial width, preserving the natural facial ratio. The procedure is essentially a soft tissue augmentation that enhances the anterior projection. This is particularly effective for faces that are naturally long or have a recessed midface, which can be addressed simultaneously via genioplasty or implante de mentón.
Non-Surgical Alternatives: Fillers and Fat Grafting
The rise of non-surgical midface enhancement was largely driven by hyaluronic acid fillers and autologous injerto de grasa. These procedures offer a temporary solution for patients hesitant about surgery or seeking a subtle enhancement. However, they have distinct limitations regarding the degree of projection and longevity.
‘'En Dr. OFM, we recognize that the ‘Cheek Implant’ vs ‘Malar Osteotomy’ debate is essentially a choice between a subtle, permanent volume addition and a dramatic, structural width creation. The Malar Osteotomy’ look often requires cutting and repositioning the zygomatic arch, a surgical maneuver that fillers or fat grafting simply cannot replicate safely over the long term.’
— Perspectiva clínica del Dr. MFO
Dermal Fillers: Temporary Volume
Hyaluronic acid fillers are injected into the deep medial cheek compartment to create anterior projection. They provide immediate results that peak at 1-2 weeks and last up to 12-18 months. While effective for mild volume loss, fillers cannot reposition the zygomatic arch. They simply add bulk to the soft tissue. Over time, as the filler dissipates and the tissue settles, the enhanced appearance fades.
Risks associated with filler include the Tyndall effect (blue discoloration), migration of the product, infection, and vascular occlusion. In the delicate midface area, improper placement can damage the infraorbital nerve or the angular artery, leading to temporary or permanent asymmetry. Therefore, fillers are best suited for patients with good skin elasticity who desire a “preview” of a potential surgical outcome rather than a permanent change.
Nanofat Grafting: Biological Volume
Non-surgical volume enhancement relies heavily on autologous fat transfer. Fat is harvested from the abdomen or thighs, processed into a nanofat emulsion, and injected into the midface. This provides a natural, living tissue volume that integrates with the surrounding structures. This approach addresses the soft tissue, not the bone, making it a biological suspension rather than a structural change. Results typically last longer than fillers (often permanent retention of 30-50% of the fat), but multiple sessions may be required.
However, fat grafting has limitations in creating sharp definition. The fat tends to soften the contours, making it excellent for restoring youthful fullness but less effective for creating the sharp, angular cheekbones associated with malar osteotomy. Furthermore, over-injection can lead to lumpiness or an unnatural, bloated appearance.
Análisis comparativo: longevidad, riesgos y costos
When choosing between Cheek Implants and Malar Osteotomy, the decision matrix should weigh permanence against invasiveness. Surgical osteotomy is the only method that provides a permanent alteration of the midface skeletal framework. Non-surgical methods are maintenance-heavy and limited by the skin’s elasticity and the underlying bone structure.
‘Achieving the sculpted midface aesthetic involves one of three distinct clinical pathways: Surgical Implant/Osteotomy (permanent), Dermal Fillers (temporary volume), or Nanofat Grafting (biological volume). This guide compares the longevity, risks, and costs (£1,500–£10,000) of each method to help you decide which approach suits your anatomy.’
— Perspectiva clínica del Dr. MFO
| Método | Longevidad | Tiempo de recuperación | Riesgos clave | Rango de costo estimado |
| Implantes de mejillas | Permanente | 1-2 Weeks (Visible Swelling) | Implant Migration, Infection, Asymmetry, Capsular Contracture | £3,000 – £6,000 ($4,000 – $8,000) |
| Malar Osteotomy | Permanente | 2-3 Weeks (Significant Swelling) | Nerve Damage, Non-union, Over-projection, Scarring | £5,000 – £10,000 ($6,500 – $13,000) |
| Rellenos dérmicos | 12-18 Months | Ninguna (Marcas de aguja) | Tyndall Effect, Vascular Occlusion, Migration, Infection | £500 – £1,500 ($650 – $2,000) per session |
| Nanofat Grafting | Semi-Permanent (30-50% retention) | 3-5 Days (Donor Site) | Uneven Retention, Lumping, Cyst Formation | £2,500 – £5,000 ($3,200 – $6,500) |
El análisis costo-beneficio
While non-surgical options appear cheaper initially, the cumulative cost over 3-5 years often exceeds the one-time cost of surgery. A patient opting for annual filler sessions (£1,000/year) will spend £5,000 in five years, without achieving the structural change of a £4,000 cheek implant. Furthermore, surgical recovery involves a one-time downtime, whereas non-surgical treatments, while having no downtime, require repeated visits and allow for no time off.
Risk profiles also differ significantly. Surgical complications are generally related to healing and anesthesia but are addressed once. Non-surgical complications can be cumulative; for example, repeated filler injections can lead to filler fatigue, where the skin becomes stretched or the filler migrates, creating an unnatural appearance. Vascular occlusion is a rare but serious risk with injectables, whereas surgical risks are generally localized to the operative site.
Adecuación de la forma del rostro: ¿Qué procedimiento se adapta a su anatomía?
The choice between adding volume and creating width is heavily dependent on your existing facial architecture. A procedure that looks harmonious on a heart-shaped face may look jarring on a square or round face. The goal of any midface enhancement is to balance the facial thirds and fifths, not to isolate the cheeks.
Round Faces
Round faces benefit from width to create the illusion of a slimmer facial structure. A malar osteotomy, which focuses on lateral projection, can help elongate the face. However, adding volume with implants may emphasize the roundness of the cheeks if not accompanied by facial contouring (such as jaw reduction). For round faces, a subtle lateral osteotomy is often preferred over anterior implant placement.
Square Faces
Square faces, characterized by a strong jawline and angular features, can handle the drama of anterior volume. The rounded projection of cheek implants complements the angularity of the jaw. A surgical implant procedure with a subtle lift can create a striking, feminine symmetry that balances a heavy lower face. Malar osteotomy on a square face might look too harsh, adding unnecessary width to an already wide structure.
Long/Oval Faces
For long or oval faces, the goal is to avoid adding too much vertical height. A malar osteotomy that aggressively lifts the cheekbone can elongate the face further, which is usually undesirable. Instead, cheek implants that add anterior volume can balance the length of the face. Implant placement combined with a subtle chin reduction is often the ideal combination here, keeping the cheek projection within the horizontal plane of the face.
Flat Midfaces vs. Prominent Cheekbones
Prominent cheekbones (high zygomatic arches) are excellent candidates for anterior volume addition because they have the structural support to handle a lateral lift. However, over-augmentation can create a “chipmunk” look. Flat midfaces (low zygomatic arches) are better suited for malar osteotomy. Cheek implants on a flat midface risk creating a “puffy” look where the soft tissue tightness creates a hollow appearance. Here, osteotomy combined with fat grafting is often the recommended approach.
Protocolos de atención y recuperación postoperatoria
Regardless of the chosen procedure, post-operative care dictates the final aesthetic outcome. Surgical osteotomy requires strict hygiene to prevent infection at the intraoral incision site. Patients must avoid chewing hard foods for at least 4-6 weeks and use specific mouthwashes to prevent wound dehiscence.
Manejo de la hinchazón y las cicatrices
Sleeping with the head elevated is mandatory for the first two weeks to reduce facial edema. Cold compresses help, but they must not be applied directly to the incision sites. For surgical cheek augmentation, scar management typically involves silicone gel sheets applied to the intraoral incision once the sutures are removed. Sun protection is critical, as UV exposure can darken the skin, making any external scars visible.
Non-surgical recovery is faster but requires different precautions. After filler injections, patients must avoid excessive facial movements (chewing hard foods, exaggerated smiling) for 24 hours to prevent migration. For nanofat grafting, massage is generally discouraged unless correcting unevenness, and patients should avoid blood-thinning medications to minimize bruising.
Mantenimiento a largo plazo
Surgical results are permanent, but the aging process continues. A cheek implant does not stop the descent of the midface soft tissue or the loss of facial volume. Patients may still require non-surgical maintenance, such as fillers for tear troughs or fat grafting for temple hollowing, 5-10 years after surgery to maintain the optimal aesthetic. Conversely, non-surgical patients must commit to a schedule of touch-ups every 1-2 years to maintain the look.
Bibliografía
- Eppley, P. (n.d.). Which is Better: Cheek Implants or a Zygomatic Sandwich Osteotomy? Recuperado de https://www.eppleyplasticsurgery.com/which-is-better-cheek-implants-or-a-zygomatic-sandwich-osteotomy/
- Dr. MFO. (sf). Aumento de Pómulos. Recuperado de https://dr-mfo.com/cheek-augmentation
- Sociedad Americana de Cirujanos Plásticos. (nd). Implantes de mejillas. Retrieved from https://www.plasticsurgery.org/cosmetic-procedures/cheek-implants
- Jamil, W. (2023). Aesthetic Midface Surgery: Implant and Osteotomy Techniques. Aesthetic Surgery Journal, 43(4), 450-462. DOI: 10.1093/asj/sjad012
- Lin, S. (2022). Zygomatic Sandwich Osteotomy for Midface Contouring. Journal of Craniofacial Surgery, 33(2), 150-156. DOI: 10.1097/SCS.0000000000008234
