Cheek Implants (Cheekbone Enhancement); Submental Direct Fat Excision. This 48 year-old woman requested cheekbone enhancement as she felt this area of her face was too flat and without shape, and she was bothered by her neck fat. She came to Minneapolis Plastic Surgery for cheek implant placement (solid silicone anatomic malar shell) via lower eyelid incisions. She also had fat excised beneath her chin in the anterior neck area at the same operation (via separate submental incision), defining her jawline better and slimming her neck. Note the improved definition of her cheekbones in the post-op photos (as well as the absence of visible scars). Intraoral incisions for cheek implant placement are touted as being “scarless” but the potential for infection of the implant(s) via mouth bacteria is unacceptably high, in our opinion, especially when the eyelid approach allows rejuvenation of the lower lids (if needed) at the same operation.