Malarplasty

Malarplasty, or cheekbone surgery, is the operation that changes the size, shape and projection of the cheekbones (the malar or zygomatic bones) to balance the face. It can be augmentation, with implants or the patient’s own fat, or reduction, when the cheekbones are too wide or prominent and the bone is reshaped. It is done for cosmetic reasons and also for reconstruction, for example after fractures or in facial malformations.

What malarplasty is

Types of malarplasty

There are two main types of malarplasty:

• Augmentation malarplasty: adds volume and projection to the cheekbone. It is done with malar implants, synthetic pieces (silicone or porous polyethylene) placed on or just below the bone, or with fat grafting from the patient’s own body. Implants are permanent; fat partly integrates and the result is less predictable.
• Reduction malarplasty: narrows a face that is very wide at the cheekbones by cutting and repositioning the zygomatic bone and its arch. It is especially common in some Asian countries.

When malarplasty is indicated

Augmentation malarplasty is considered for people with flat or poorly defined cheekbones from birth, or when with age the midface loses volume and the cheek “drops”. When the cheekbone sits behind the eye in profile (a negative vector), the eyes look more tired and the lower eyelid loses support. Reduction malarplasty is indicated for overly prominent cheekbones. In reconstructive surgery it is used to correct asymmetry after fractures, tumours or malformations.

Recovery and results of malarplasty

How to judge results

To understand what malarplasty can achieve, it helps to look at before and after photos of real cases, paying attention to the shape of the cheekbone, the smooth transition between cheekbone and cheek and whether the result fits the rest of the face. Make-up, lighting and expression can exaggerate the effect, so comparing several photos and angles helps keep expectations realistic.

How long results last

Malarplasty results with implants are permanent. With fat grafting, part of the fat is reabsorbed in the first months and what remains afterwards is stable. In reduction malarplasty the bone change is permanent. By comparison, cheek augmentation with hyaluronic acid is temporary and has to be repeated, although it is reversible and needs no surgery.

Recovery after malarplasty

After malarplasty, swelling and tightness peak in the first two or three days and go down mainly over the first weeks; the final result shows after a few months, once residual swelling has gone. Bruising, local discomfort and temporary numbness of the upper lip, cheek or teeth are normal. If the incision is inside the mouth, oral hygiene needs extra care and a soft diet is followed for a few days. Strenuous exercise and heavy lifting are avoided for a few weeks, as advised by the surgeon.

Risks and things to consider in malarplasty

Risks and complications

In a 2025 meta-analysis of 3,701 patients and more than 4,000 facial implants, malar implants had the lowest complication rate of all facial implants, 7.4%, compared with 10.7% overall. Possible complications of augmentation malarplasty are:

• Asymmetry or implant displacement, prevented by fixing the implant to the bone, sometimes with a small screw.
• An implant that shows or can be felt too much; in one review, malar implants had more problems of this kind than chin or jaw implants.
• Infection: in another review, implants in the cheekbone and forehead had the highest infection rates (around 2.5–2.7%), and porous implants became infected more often than non-porous ones.
• Changes in sensation of the cheek, lip or teeth, usually temporary.

In reduction malarplasty, a meta-analysis of almost 6,600 patients concluded that L-shaped osteotomy without bone resection had the fewest complications.

Cover and returning to work

In Spain, cosmetic malarplasty is not covered by the public health system. When it is reconstructive, for example after a facial fracture or tumour, it is done within the health system or insurance like any reconstructive surgery. Most people can return to office work within one or two weeks.

Alternatives and techniques to avoid

To add volume to the cheekbones without surgery, the usual alternative is hyaluronic acid filler. The permanent fillers used in the past are now practically abandoned because they can cause granulomas, migration and deformities that are hard to correct. The choice between implant, fat or filler depends on how much volume is needed and whether a permanent result is wanted: one comparative study found greater satisfaction with implants when major augmentation was needed, while fat is useful for small augmentations.

How malarplasty is done

Malar implants

Augmentation malarplasty is usually done through an incision inside the mouth, between the gum and the upper lip, which avoids visible scars. Sometimes an incision below the lower eyelashes is used, especially if combined with other surgery in that area. The surgeon creates a pocket over the bone, places the implant in the position that best suits the face and fixes it so it does not move. It is done under general anaesthesia or local anaesthesia with sedation and usually takes one to two hours.

Zygomatic osteotomy

A less common technique is zygomatic osteotomy, in which the cheekbone is cut and repositioned, outwards to augment or inwards to reduce, and fixed in its new position. It is the basis of reduction malarplasty and is also used in reconstructive surgery for malformations and trauma. As facial skeleton surgery, it is performed by maxillofacial or plastic surgeons experienced in this area, and it is often combined with other facial profile techniques, such as chin surgery or orthognathic surgery.

Candidates for malarplasty

Good candidates for malarplasty are healthy people who want to improve the shape of their cheekbones or the balance of the midface, both young people with flat cheekbones and older people who have lost volume with age. Men also request it, usually wanting more defined cheekbones without feminising the face. It is essential to choose a surgeon experienced in facial anatomy and this type of surgery, and to have a clear conversation about what can be achieved.

Frequently asked questions about malarplasty

Are cheek implants better than fillers?

Cheek implants are neither better nor worse than hyaluronic acid filler: they are different. Implants give a permanent result and stronger projection, but require surgery. Hyaluronic acid is temporary and reversible, with no surgery, and suits moderate augmentation. The choice depends on how much volume is wanted and whether something permanent is preferred.

How long do cheek implants last?

Cheek implants are designed to last indefinitely. They are only removed or changed if there is a complication, such as infection or displacement, or if the person wants to change the result.

What are the downsides of cheek implants?

The downsides of cheek implants are that they require surgery, that recovery involves several weeks of swelling and that there is a risk of asymmetry, displacement, infection or the implant showing. In a meta-analysis, the complication rate of malar implants was 7.4%, the lowest among facial implants.

Is cheekbone surgery painful?

Cheekbone surgery does not hurt during the operation because of the anaesthesia. Afterwards there is discomfort, tightness and swelling for the first days, controlled with painkillers, improving over one or two weeks.