I am a 44 y.o. male who is concered with what once were likely "chipmunk cheeks" now making a steady progression southward, as well as "flat" cheekbones and a weak chin. The combination of these factors has given me what has been described as a "squat" or "boxy" lower face. A mid-face lift has been recommended, but I am also wondering if cheek implants along with a chin implant would be enough to "take up the slack" so to speak. I'm just not sure if a full facelift is right for me at this point.
Mid-face Lift vs. Cheek and Chin Implants
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Facial Sculpting of Cheeks and Chin
Thank you for your question. Flattening of the face occurs primarily from volume loss, in addition to sagging of skin and tissue. A flat cheek may give the appearance of aging or less attractive. Options include a silicone cheek implant, facial fillers (Radiesse, Sculptra), or fat injections. Cheek implants are great permanent solution. Your questions suggest underlying bone structure weakness that may benefit from both chin and cheek implants. A midface lift or face lift has not been the first option for younger patients who have weak cheeks and chins. Only after a comprehensive evaluation can a plastic surgeon help determine appropriate options for you. Best of luck.
Midface rejuvenation - first identify the aging mechanism.
Your situation illustrates a common dilemna faced by people interested in facial rejuvenation procedures. The key to achieving youthful and natural results is to first perform a careful assessment and identify the cause of the aged appearance in each individual. Facial aging can be categorized into three basic groups known as the 3 D's: 1) Deterioration of the skin surface, 2) Deflation or loss of volume and 3) Descent of the facial tissues. Once the role that each of these aging processes is playing is assessed in each individual then the proper corrective procedures can be selected, depending on the patients desires. One of the hallmarks of facial aging is that the basic shape changes from a triangle in which the base is located across the cheeks and the apex towards the chin during youth to an inverted triangle in which the base is now located across the jowls and the chin and the apex is across the midface. This finding can be viewed as a "boxy' look through the lower face.
In this 44 year old male it is likely that the full cheeks characterisitc of youth have given way to a flattened appearance due to a combination of deflation and descent. Revolumization procedures such as injectable fillers, fat transfer or placement of cheek implants will all restore the fullness of the cheeks. Injectable fillers are quick and simple but the results will only last 1 to 2 years at most. Fat transfers and even better, cheek implants are a more permanent method or restoring lost volume. Surgical lifting of the cheek region can be accomplished through either an extended facelift approach or through a midface lift technique. I view these procedures as a means to reposition tissues that have descended "southward" due to th effects of gravity and weakening of the zygomatic retaining ligaments over time. If you are not ready for a full surgical lifting procedure then an isolated midface lift plus cheek implants would be a good alternative to reposition the descended tissues and restore volume.
As far as the chin and neck is concerned, it is likely that some early signs of jowls and perhaps a heavy appearance due to some fat accumulation are combining to give a "weak chin" appearance. These are all the result of descent of tissue under the influence of gravity. The ideal correction would indeed be a lower face and neck lift combined with submentoplasty. However, if you are not ready for this then a chin implant combined perhaps with liposuction will provide enough improvement.
Sagging cheeks- cheeklift or facelift
Each operation does something different.
Augmentation of the cheeks can be accomplished with implants, or with the patient's own tissues.
Reduction in the buccal fat pad can be accomplished through the mouth. It is very effective for patients with "chipmunk cheeks".
Cheeklifts (and there are many different types) help the lower eyelid and cheekpad position, as well as the eye-cheek junction, depending on the technique (and the surgeon).
Facelifts which employ the high SMAS technique reconstitute the lateral cheek well. Conventional SMAS facelifts do not.
Below are referenced various articles we have written on cheeklifts and midface lifts.
Web reference: http://www.drbrent.com/cheek-liftprocedure.php
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Mid-face Lift vs. Cheek and Chin Implants
It is very difficult to answer your question without seeing your pictures – but based on your description you appear to be a good candidate for a chin implant and cheek implants.
Buccal fat removal will at times help with the chubby cheeks, such as in the link below
See a Board Certified Plastic Surgeon for a facelift consultation. I would put the implants down the list as options to consider. They can be effective in the short term, but in the long term, they can cause some bone erosion as I have witnessed on many occasions.
Web reference: http://www.elitemdspa.info/
Aging Midface in a Male
I would consider re-inflation of your cheeks with volume (filler) or implant over a mid or face lift at this point. One has to determine if you problem is more of a bone or soft tissue deficit or both. In your case, a detailed exam is critical to determine options. Find someone you trust and whose results you admire. Good luck!
Web reference: http://www.vargasfaceandskin.com/body-procedures.php
Try fillers to plump cheeks and chin before considering surgery-will give you an idea of the result to expect
Today most Plastic Surgeons feel that facial volume restoration in the mid face is a better solution to aging changes in the mid face than surgical Mid Face Lifting.
Cheek and chin implants may be your solution.
An easy way to analyze for yourself what you can expect from these procedures is to first have filler injections using a substantive filler such as Perlane or Radiesse to plump the cheeks and enlarge the chin so you can analyse the resultnad see if you like the change.
The benefit is that you can see the effect before deciding to have surgery.
Not all doctors are equally good at filler injections. It is very important to find an experienced Board Certified Plastic Surgeon who has experience at filler injections. Be sure to ask how many your surgeon does and ask to see photos of his/her personal results
Mid-face lift or facial implants
Cheek implants are a volumetric augmentation of the cheek to give a more youthful full look to the cheek. A midfacelift is only a minor upward lift, which will not give volumetric augmentation. Flat cheekbones are best treated with a cheek implant. The implants are placed through an intraoral approach above the upper teeth and placed directly over the maxillary bone. A weak chin profile is best treated with a chin implant. This is inserted through an incision on the underneath side of the chin and the silastic implant is placed directly on top of the bone, underneath the muscle and skin. Midfacelifts give very inconsistent results.
Web reference: http://seattlefacial.com
The southward progression of your cheeks may be an illusion actually resulting from volume loss in areas above the areas of descent. A thorough evaluation to evaluate your particular aging progression is necessary. Many options exist to treat the aging midface, from fillers to fat grafting to midfacelifting to cheek implants. I think you will find that very simple and minimally invasive solutions will suffice for the treatment of much of your issues and can certainly postpone a full facelift.
Web reference: http://www.bwfacialplasticsurgery.com/
Midface lift versus cheek implants for facial rejuvenation
You pose a very good dilemma, but it's hard to make an assessment without actually examining you. A midface lift is great for restoring volume to your cheekbones, but you're limited to the skin and fat that already exists on your face. Cheek implants are great as they can add extra volume in addition to what you already have. Either way, they are both proven ways to restore lost volume to the cheeks for facial rejuvenation and they are safe procedure performed in an outpatient setting.
Web reference: http://www.BaltimorePlasticSurgery.com
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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