Dear Brooke
Cheek pad repostioning means very different thing to different surgeons. You can be sure that when there are a lot of really different ways of doing something, no one approach is best.
There are many maneuvers that are done in an effort to reposition the cheek fat pad. Some are ok and some are, to be kind, unnatural. I think that there is general agreement that over time the cheek or malar fat pad falls. What to do about this is an other matter. I am of the school that most of what makes the under eye circle and jowl is the descent of the malar fat pad. However this pad falls mostly vertically, very little of this fall is from sagging of the face from the side.
Why is it important how the face sags you might ask? The answer is that we operate passed on our theories. If a theory is not correct, well then it is likely that the surgery will also not be right. I have a vertical midface lift that I use to address the fall in the malar fat. This surgery is performed through the eyelid. However, many surgeons attempt to lift the cheek fat pad through the facelift incision or throught an incision above the ear which may or may not be part of the facelift incision. This is a so-called temporal midface lift. The problem with this approach is that the dissection pathway from the temple damages the fat in the way of the dissection. After surgery the cheek fat is pulled to a place that looks unnatural and often it looks like a bit has been taken out of the bony rim of the eye socket.
Originally surgeons also attempted to pull the cheek fat pad to the side of the face using a composite facelift in an effort to flatten the nasolabial fold. This is a very unnatural effect that results in permanent facial disfigurement.
The moral of the story is that you really need to pick your surgeon not your procedure. Consult with surgeons and attempt to assay if they make sense to you, do they answer you questions, are they kind, and do you like their work. This will help you find someone who is right for you.
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