One of the most notable signs of an aging face is the loss of volume in the midface, or the area of the cheek below the lower eyelid. With time, the malar (cheek) fat pad shrinks in size and descends into the lower portion of the cheek. This, in turn, creates a line or valley in the midface. It is this loss of volume that adds considerable age to the face, and the submalar or midface implant is designed to restore volume to this area. By three-dimensionally adding volume, youth is restored to the face. The implants are permanent, yet 100% reversible at any time.
The best candidate for a submalar implant is a patient who has lost volume in the midface or cheek area. This is seen with the normal aging process and in patients who have had significant weight loss, such as with gastric bypass patients. Nearly all patients undergoing facelift surgery can benefit from the addition of submalar implants to three-dimensionally restore volume to the face.
Dr. Caniglia performs the submalar implant surgery at the Plastic Surgery Center at Kierland (PSCK). Located in the Caniglia Center in Scottsdale, Arizona, the PSCK is a fully-equipped outpatient surgery center that is licensed by the state and accredited by the AAAHC.
Most submalar implant surgeries are performed on an outpatient basis and take between 30 minutes and an hour to complete. Dr. Caniglia performs all submalar implant procedures with deep twilight sleep, which is a combination of local anesthesia and intravenous sedation. With this form of anesthesia, patients do not remember anything from surgery nor do they feel any discomfort. They also feel more alert and refreshed after surgery. All patients have a board certified anesthesiologist present at all times to monitor their vitals before, during and after surgery.
There are various approaches to the placement of submalar implants. The intraoral approach is the most common and preferred route for placing these implants and involves a small 1 – 2 cm incision made in the gingival buccal sulcus (gum line) underneath the upper lip. Once the incision is made, a special elevator is used to create a pocket on the bone overlying the midface and cheek area. Once the pocket has been created, submalar sizors are placed to determine the correct shape and size of the implant. The permanent implants are then opened, soaked in antibiotic solution, and placed within the pocket and secured to the malar (cheek) bone with a tiny 4mm titanium microscrew. The intraoral incision is closed with dissolvable sutures.
Recovery after a submalar implant procedure is very quick. Most patients feel fine the next day, experiencing little to no discomfort. Patients may experience minor bruising, though there is often no external bruising due to the fact that the implant is placed through an inside or intraoral incision. The stitches need not be removed as they will dissolve on their own. Most patients are able to return to work within seven days, and some as early as a few days after surgery. Dr. Caniglia prefers that his patients wait 2 weeks before they return to heavy strenuous activity or exercise. As with most facial plastic procedures, complications are fortunately very rare. Some potential complications may include infection, extrusion, numbness of the upper lip, hematoma and asymmetry.