This publication discusses cheek augmentation surgery related to gender-affirming facial surgery. The publication describes the difference between the common male cheek anatomy and the desired ideal feminine appearance and how to achieve it. In the author’s experience, gender-affirming surgery patients often want volume enhancement at all ages rather than restoration of their younger appearance. The author feels that the gender-affirming surgery patients tend to be well informed and researched, and often have a precise idea of what they want. In his experience, the vast majority would like more feminine cheeks. He feels that the operating surgeon must counsel patients preoperatively to explain the limitations of the technique with the surgeon’s ability and personal experience, and recommends a detailed patient evaluation to determine the need for and extent of the augmentation required. The patient should be counselled on the available options. He has described various techniques including nonsurgical (injectable fillers) and surgical techniques used in his practice. He describes the key points for malar augmentation surgery in any techniques to be bilateral symmetry, the avoidance of overcorrection to avoid an overfilled cheeks appearance, and immediate removal of an implant in case of an infection. This is a great article for any ENT surgeon interested or performing cheek augmentation surgery related to gender-affirming facial surgery across the world.