The cheek is anatomically defined by the nasofacial sulcus and the melolabial folds medially, the preauricular sulcus laterally, the orbital rim and zygomatic arch superiorly, and the jawline inferiorly. At first, cheeks may appear to be one of the easiest areas to perform facial surgery. In fact, it may be one of the least forgiving. There are no cosmetic junctions and creases within the cheek to hide the incisions.

The use of the relaxed skin tension lines is probably more important in the cheeks than any other area on the face for this reason, especially in younger patients where wrinkles are absent. Precise markings of the relaxed skin tension lines will yield better results.

The cheek may appear to be topographically flat, but there are contours that should be preserved for optimal symmetry. Careful attention to the three-dimensional quality of the malar cheek is important, as oftentimes surgery can flatten it.

Some general rules for cheek reconstruction:

If the defect can be closed primarily in a linear or curvilinear fashion along the relaxed skin tension lines, do so.

Place the incisions either along the cosmetic borders of the cheeks, or on the lateral portion of the cheek (where it is less visible from the front).