Answer:
Prominent malar bones are considered to be a mark of beauty and contribute to a more youthful appearance. Facial attractiveness and balance require the nose and chin and malar region to be in proportion to one another. The ideal implant should be easy to place, nonpalpable, easy to exchange, malleable and conformable, biocompatible, and modifiable by the surgeon. Bone grafts placed as an onlay always resorb to a certain degree. Therefore, most use alloplastic materials. Silicone becomes fixed rapidly by a capsule and can be easily removed. Porous implants (Proplast, Porex, Hydroxyapatite) permit ingrowth but are more difficult to replace. A 4-mm augmentation in the malar/midface region usually suffices. The intraoral route is used most commonly, although the implant can be placed through coronal, subciliary or preauricular incisions. The basic operative principles are (1) stay on bone, (2) avoid soft tissue trauma, (3) do not make the pocket any larger than is necessary. The implant is secured with percutaneous pullout sutures or to the surrounding soft tissue or not at all. Complications include asymmetry, malposition, hematoma, seroma, infection (requiring removal), infraorbital nerve or buccal branch dysfunction, lip elevation dysfunction (zygomaticus muscle), and lower lid ectropion (subciliary route).