HomeHealth articlescheek reconstruction proceduresWhat Are the Various Cheek Reconstruction Procedures?

What Are the Various Cheek Reconstruction Procedures?

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Cheek reconstruction is a surgical procedure done to restore the damaged cheek area of the human face. Read to know about cheek reconstruction procedures.

Written by

Dr. Anahita Ali

Medically reviewed by

Dr. Kumar Sonal

Published At June 23, 2022
Reviewed AtJuly 16, 2023

Introduction

Cheeks are an important part of the human face. A cheek is a soft tissue surface that covers both sides of the face and extends its borders to lips, eyes, ears, nose, and neck. Various human facial expressions are supported by cheekbones and cheek muscles. Although the size and shape of the cheeks vary from person to person, it carries the same aesthetic importance in every person.

Damages or defects in the cheeks sometimes require reconstructive procedures. These procedures are intended to restore the esthetics and function of the cheeks. It is a complicated procedure because matching the skin color and restoring the functions are a bit challenging. The cheek reconstruction can be performed by various methods because there is no gold standard technique.

What Is Cheek Reconstruction?

It is a surgical procedure done to repair the damaged or defective cheek area of the human face.

What Is the Anatomy of Cheek?

A cheek is a flat surface made of soft tissues. The outline of the cheek includes the nose, ear, eyes, neck, and lips. The borders of the cheek are not fixed and change with time, person to person, hairline, etc. It is divided into three zones that carry esthetic value:

  1. Suborbital.

  2. Periauricular.

  3. Buccal Mandibular.

Why Is Cheek Reconstruction Needed?

The most important indications of cheek reconstruction are:

  • To achieve esthetic results.

  • To restore the functionality.

  • Adequately match the texture and skin color.

What Are the Various Buccal Cheek Defects?

Buccal cheek defects can happen due to any of the following reasons-

What Is Cheek Bone Reconstruction Surgery?

Cheek reconstruction is a complicated procedure that is mainly focused on restoring function, shape, and esthetics. There are several procedures for this purpose, such as skin grafts, flaps, etc. Based on the incision design, there are different techniques:

1. Anterior Rotation Advancement Flap: It is a one-stage procedure; done for large defects present in the front and backside of the cheek. The flaps may be taken from the cheek, neck, or chest area.

  • The incision is made transversely from the upper side of the defect, around the side of the defect, downwardly from the periauricular zone, and goes towards the earlobe and hairline.

  • For larger defects between 6 to 10 cm, the incision is extended from the hairline to the neck and chest of the patient.

  • The donor site is left open for secondary intention healing.

2. Posterior Rotation Advancement Flap: It is done for smaller and medium-sized front cheek defects.

  • The incision is made behind the nasolabial fold, goes across the jawline and in front of the anterior submental crease, and ends as a back cut.

  • The flaps taken are subcutaneous, meaning that they are highly vascularized through superficial temporal artery in the face, vertebral and occipital artery in the neck, and thoracoacromial vessels in the chest.

  • The donor site is closed with a V-Y advancement skin graft taken from the cervical region.

3. Split Ascending Neck Flap: This subcutaneous flap is taken from one or both sides of the neck.

  • The incision extends 6 to 8 cm in length, below the clavicle, into the chest area of the patient.

  • It can be extended up to 6 cm to cover the chin area and lower cheek.

  • The platysma muscle is not included in this technique to improve mobility and decrease soft tissues.

  • A second stage advancement procedure can be done after six months in which the flap can be readvanced above the cheek and infraorbital area and towards the chin and lips.

4. Random Skin Subcutaneous Flap: These are used for smaller defects. These are less vascular and cause complications such as necrosis of the flap.

5. Deep Plane Composite Flap: It is used in deep, large, and complex defects. The flap has a deep subcutaneous thick layer of tissues.

6. Serial Excision and Skin Expansion: Skin expanders expand the surface of the donor site and minimize the scar formation.

  • Few subcutaneous expanders are placed into the platysma muscle, perpendicular to the defect.

  • The cervical skin is expanded by 30 to 50%, and the flap is taken or advanced.

7. Classic Limberg Flap: The flap is shaped into a rhombus with two 60 degrees and two 120 degrees angles. It is used for rhomboidal-shaped defects.

8. Dufourmental Variant: It is another variant of the Limberg flap used in medium-sized defects of a rhombus shape. This flap can be designed with any combination of angles.

9. Webster Flap: It is another modification of the Limberg flap, used in perilabial cheek. It is also called 30 degrees rhombic flap. It has both the components of the Limberg flap and the dufourmental flap.

What Are the Common Donor Sites For Cheek Reconstruction Flap?

Mostly, the local flaps are used adjacent to the defect. Other commonly used donor sites are the neck, cheek, and chest of the patient.

What Are the Complications Of Cheek Reconstruction?

  1. Flap Necrosis: If the flap is less vascularized or has less blood supply or is placed under high tension, then the flap may become necrosed or dead. The necrosis can be superficial, partial, or total, depending on the tissue area necrosed.

  2. Edema: The edema or swelling of the lower lid may occur commonly.

  3. Abnormal Hair Growth and Distribution: Because the cheek skin type in men and women differ, men have beard pattern skin, and women have shiny skin. Care should be taken while placing the flap on such a skin type. Putting a shiny skin flap over the beard pattern skin must be avoided.

  4. Aesthetic Complications: Loss of symmetry, skin color mismatch, etc., may result from inappropriate tissue or flap selection.

What Is the Cheek Reconstruction Recovery Time?

The complete healing and recovery may take up to ten to 12 weeks. The common signs of healing, such as bruising, swelling, etc., may go away in seven to ten days.

Conclusion

Cheek reconstruction is a type of esthetic reconstruction primarily focused on restoring the function of the cheeks. It is best to use local flaps whenever possible to perfectly match the skin color, texture, and contour restoration. As compared to the other parts of facial reconstruction such as the nose or lip, cheek reconstruction is less complicated. The best results can be achieved by using transposition flaps or advancement flaps because these are versatile and can be used in small to medium-sized cheek defects.

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Dr. Kumar Sonal
Dr. Kumar Sonal

General Surgery

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