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Cheek Augmentation Before and After: The Procedures Explained

Medically reviewed by Jennifer Richman on January 24, 2024.

Understanding Cheek Augmentation

Cheek augmentation procedures increase the volume of the cheeks temporarily or permanently. These surgical and non-surgical procedures are designed to give the cheeks a fuller, rounder appearance and make the cheekbones look more pronounced. This is often to give the face a more heart-shaped appearance, achieve greater facial symmetry and help facial feminization surgery (FFS) patience experience greater gender alignment.

Cheek augmentations can occur through the injection of temporary fillers, liposuction fat transfer or silicone implants. In this article, we go over cheek augmentation before and after results and information for each of these three procedures.

Cheek Augmentation for Facial Feminization Surgery

One of the bodily processes that the sex hormones––testosterone and estrogen—regulate is the distribution of fat throughout the body. For many people, when estrogen exists in more elevated levels in the body, fat tends to accumulate more in the cheeks and jawlines. When cisgender women enter menopause, some experience facial fat loss as estrogen levels drop, which can give a more hollowed-out look to the cheeks over time.

A common effect of an estrogen-dominant puberty is that the cheekbones sit higher and appear more prominently on the face. Cheek augmentations can help make the appearance of cheekbones and/or cheek fat more prominent and give the face more of a heart shape.

Transfeminine people who take estrogen hormone replacement therapy will start to see body and facial fat redistribute about 3-5 months after starting treatment. If you are not microdosing, it can take anywhere from 2-5 years of HRT for your fat to finish redistributing.

Below, we describe why patients might choose between the different types of cheek augmentations–from surgical invasiveness to permanence–as well as the recovery processes involved.

The Procedure: Cheek Augmentation Fillers

Another way that our surgeons can enhance the cheek bones is through the injection of filler. There are a variety of different available types of filler, with each staying in the body a different amount of time (ranging from 6 months to two years). When fillers are used to augment the cheeks, patients are not required to adhere to any activity limitations. Fillers are also an outpatient procedure, meaning if patients just want cheek fillers these can be placed in the office without any need for anesthesia. This option is less permanent than fat transfers because the fillers will be absorbed into the body over time, but some patients prefer this method in order to avoid surgery or anesthesia. Some patients use temporary filler to determine if they would like augmented cheek bones prior to undergoing fat transfer or implants–more permanent changes–to the face. In general, filler is less expensive than fat transfer because the patient will not need to pay for the operating room or anesthesia associated with fat transfer. However, with repeated filler injection, there might not be any cost savings.Furthermore, filler is not commonly covered by insurance, whereas other cheek augmentation procedures may be covered.

The Procedure: Fat Transfer Cheek Augmentation

With fat transfers, our surgeons take fat from other parts of the body and deposit it into the cheeks. This option for cheek augmentations yields semi-permanent results. Usually with this procedure about 50-60% of the transplanted fat will survive the transplant. A patient can try to optimize their chances of good fat survival by avoiding strenuous activity for 4 weeks following this procedure. Avoiding strenuous exercise helps to create conditions that are more suitable for fat transfers to survive where they are transferred rather than be absorbed back into the body. In some patients, multiple rounds of fat grafting may be performed in order to achieve the desired result.

The Procedure: Silicone Implant Cheek Augmentation

Another permanent option for patients seeking cheek augmentations are silicone implants. Silicone cheek implants are surgically attached with sutures or a screw to the patient’s zygoma, or cheekbone. Implants can be placed on the malar area to increase the volume of the apples of the cheeks or the submalar area to create a rejuvenating or anti-aging effect.

To insert the implants, two incisions are typically made inside the mouth, above the upper gums. As a result, scarring for this procedure is completely invisible, just like the other two approaches to cheek augmentation that we offer. Unlike fat transfers, the insertion of a silicone implant is completely reversible. That said, we do advise patients that this procedure holds a few more risks than a fat transfer, such as malposition, infection, or fluid collection around the implant. Please discuss these further with your care team.

Preparation for Cheek Augmentation

At this time, at the GCC (Gender Confirmation Center), we only offer surgical cheek augmentation options: fat grafting and silicone implants. Generally speaking, hyaluronic acid injections are offered by certified estheticians and nurses and will not be covered by insurance as a medically necessary gender-affirming procedure. Our surgeons may be able to offer facial filler injections to select patients who are able to pay out-of-pocket.

The first step in undergoing a cheek augmentation surgical procedure is to request a consultation with the surgeon or surgeons you are interested in undergoing FFS with. At the GCC, all of our virtual and in-person surgical consultations are free of charge to patients. You can request a consultation with both Dr. Ley (she/her/they) and Dr. Facque (he/him). For your FFS consultation, you will be asked to submit photos of your face in advance for surgical evaluation.

Once you have requested a consultation, if you like your insurance to help you cover the costs of FFS, you will need to submit documentation for pre-approval. Generally speaking, this will involve sending your surgeon’s office a copy of your health insurance card and a support letter from a licensed mental health professional. At the GCC, our insurance advocacy team has a 90% success in securing coverage for interested patients. For more information, click here.

Recovery and Aftercare

Cheek augmentation recovery depends on the method of augmentation. As stated above, it is not associated with any long term activity or lifestyle restrictions when performed alone, and therefore is sometimes preferred over fat transfers or silicone implants for this reason.

On the other hand, when the fat transfer method is used, our practice recommends that patients restrict strenuous activity for 4 weeks to help support their healing and the survival of the fat in its new location.

Lastly, for silicone cheek implants, our practice asks patients to maintain a soft food diet for two weeks post-operation. Since the incisions are inside of the mouth, sharp or hard foods can break stitches before they naturally absorb into the body, aggravating the area and potentially. Likewise, it is common for patients to feel some initial pain and discomfort from the implanted material or sutures, which should subside in the first few weeks of recovery.

Patient Satisfaction and Outcomes

Research has demonstrated that FFS generally yields high rates of patient satisfaction and many benefits, including:

• Reduced instances of anxiety and depression
• Improved body image
• Improved self-esteem
• Reduction of gender dysphoria

Anecdotally, our practice has noted that cheek augmentation is one of the most quickly gratifying procedures for patients because the results are visible almost immediately. That said, swelling and bruising below the eyes is expected right after surgery, and will subside during the first few weeks of recovery. Having the appearance of fuller cheeks and more pronounced cheekbones tends to leave patients feeling satisfied with their results sooner than with other FFS procedures like jaw contouring, which takes significantly longer for swelling to resolve and final results to be visible.

Potential Risks and Considerations

Like any facial surgery procedure, there is a slight probability of risk. Cheek augmentation patients should expect to experience facial bruising and swelling in the surgical site during the recovery period. Patients may also run the risk of experiencing infection, seromas (fluid build-up), hematoma (bleeding), adverse reaction to anesthesia, eye irritation or changes in skin sensation. We encourage patients to be honest with their surgeon about their medical history so that we can ensure you are safe during and after surgery.

There are many steps that patients can take before surgery to lessen their risk of complications. For example, quitting tobacco can help prevent issues with delayed healing and tissue necrosis (i.e., fat that is transferred into the cheeks not holding). You can talk to a surgeon in a free consultation about what lifestyle changes of medical accommodations can be made to reduce your risk of surgical complication.

Long-Term Considerations

Unlike fillers, the results of fat grafting and silicone implants are permanent. With a fat transfer, there is a greater risk that the fat injected into the cheeks does not hold. Generally speaking, if you undergo a fat transfer, your surgeon will overfill the zone because at least 30% of the fat injected is expected to be lost during the first stage of recovery. Whatever fat holds by the 6 week post-op mark is your final result. However, significant weight loss post-op–i.e., fat loss throughout the body–can cause results to diminish. On the other hand, the advantage of silicone cheek implants is that the results are guaranteed to be permanent unless the implants are removed.

Choosing the Right Provider for Cheek Augmentation

For any surgery you undergo, it is essential that you make sure your surgeon is board-certified. Especially for facial surgery, your surgeon should have hospital privileges so that if you need to spend the first night in the hospital or if something goes wrong, you will be able to access care.

Every facial surgeon has a different style when it comes to creating a unique, surgical plan for your FFS. Some patients may wish to have multiple FFS consultations with different surgeons to see which one they feel most comfortable with.

Conclusion: Weighing the Benefits of Cheek Augmentation

We hope the information in this article about different forms of cheek augmentation can help you determine which, if any, of these procedures are right for you. Some patients find it helpful to explore photo-editing applications or show their surgeon photos that resemble the final results they would like to have to see if a cheek augmentation would be right for them. If you have specific questions about the benefits and risks of a particular procedure, you can ask your surgeon in a free consultation.

Gender-affirming facial surgery patients have consistently reported high satisfaction rates, improved self-image, higher self confidence and reduced gender dysphoria after they make it past the difficulties of the recovery process.