What works to tighten sagging skin on your cheeks?

There are many ways to reduce the appearance of wrinkles on the skin.

If the patient is looking for a temporarily or minimal solution, light peels, Juvederm, radiofrequency devices, etc wil help somewhat.  We have been discouraged by the string and ribbon lifts as they seem to have very limited longevity.

For patients wanting to obtain a more permanent result, a facelift will tighten lateral cheek skin best.  If a volume enhancing facelift is performed, especially with SMAS elevation and LiveFill (nonaspirated fascial fat grafts), even better.

For areas below the eyes into the cheeks (the midface), a facelift is usually a weak option, and the patient may wish to consider midface elevation with a cheeklift of some type.  There are several articles in our Mathes Plastic Surgery textbook chapter and Plastic and Reconstructive Surgery journal articles which highlight some of the current techniques.  http://www.drbrent.com/article_mathes.php

When a cheeklift is performed, the tissue of the midface (area below the eyes) can be lifted in a subtle fashion, tightening the skin.  This is not the same as performing a blepharoplasty and removing skin, since that can pull down on the eyelid and change its shape to drooping or round.  Our most advanced cheeklift lifts also restore volume to the lower eyelid (LUSIC cheeklift) with LiveFill, or fascial fat grafts obtained from the patient.  It is important to preserve the shape of the lower eyelid.  It is also important to restore lost volume whenever possible.

If the facial shape warrants it, a cheek implant may also be considered.  I usually reserve this option for patients who need three dimensional augmentation in the malar or submalar regions, not just to combat aging, although this is a controversial area even among excellent surgeons!

Last, conservative CO2 laser resurfacing helps to tighten the skin further, and reduce surface sun damage and wrinkles.

When you say that you have significant laxity in the cheeks, there is nothing like properly done surgery to improve the situation. Sometimes, when the laxity is less severe, volume enhancement with injectable fillers or fat injections can tighten the skin and lift it a bit. Lasers and medical grade skin care can also add a sense of tightening to the lax skin. Combinations of these treatments are sometimes prescribed to maximize the benefits.

Consult with an excellent plastic surgeon who can do all of the procedures so you can find out which will give you the result you want. Remember that if the doctor you see can't do all of the procedures, they might just recommend the ones which they can do and this won't be in your very best interest.

It's good to know that you have non-surgical alternatives to snug up lax face and  cheek skin.  We offer a "non-surgical facelift": face/neck Thermage, face/neck Portrait, and jowel/chin/neck CoolLipo.  The result is a natural, believable lifting of the face, cheeks, jowels, and neck, plus a beautiful regeneration of the skin - an effect absent with surgery.  In addition, where appropriate, we restore lost subcutaneous volume with durable fillers such as Sculptra and/or Artefill.  We all lose cheek volume as we age, and it is a common finding in the aging face.  The skin tightening mode of CoolLipo is fantastic in snugging up lax, bulging jowels.

Facelifting is the most obvious answer.  This can help elevate soft tissue that has fallen and take up extra skin. There are some lasers that can tighten the skin, but in my hands they only give about a 20% improvement.  The advantage to the lasers are that they result in very little down time and are ideal for the patient with only mild laxity and who doesn't want to undergo a facelift.  Facial skin laxity can also be the result of "deflation" or the face or facial fat atrophy. Soft tissue fillers can plump the face to fill it out a bit. This can be done in conjunction with all the other techniques that I have described.

Dear Triss,

Of course the standard surgical facelift gives the longest results but is expensive and carries more risks than the quick fixes.  Most people prefer a quick easy safe procedure which is done under local anesthesia and gets you back to work in a few of days.  This describes the Silhouette/Ribbon Lifts which are threads and devices which are easily slipped under the skin to raise up the sagging skin.  They can last up to 3-5 yrs and cost roughly $3500-5000.

Other adjunctive procedures like fat injections or various fillers can supplement the Lifts quite nicely and are recommended as well but don't give as nice of results by themselves.  I like to combine them and also most patients benefit from a medium depth TCA chemical peel which can be done at the same time for an additional cost of roughly $1000 for the peel.

There are many options for sagging cheeks. If the problem is a volume issue, fat transfer from the abdomen or thighs can be a good option. This is a permanent solution but can take a time or two to get the desired result. For a quicker fix, artificial cheek implants are a good option. If you do not like the result, removal is easy and you are back to where you started.

If skin laxity is a concern, a midface lift may be your solution. This helps to lift and tighten sagging tissues. Ablative laser treatments can help to decrease wrinkles as well.

To determine which is the best option, consultation with an experienced surgeon is your best option.

Good luck.