I've noticed that in most people 25 and younger, they have less space between the apple of their cheeks and their under-eye area, creating a "lifted" look. Is there a way surgeons can shrink a stretched cheek-to-eye space vertically, neither using fillers to "balloon" the area nor traditional diagonal face-lifts that can create a stretched cat-face look? Or would any type of incision anchor down the under-eye area?
Is There a Way to Lift the Cheeks Vertically Rather Than Horizontally?
Doctor Answers (10)
Vertical Cheek Lift
Cheek Lift Can be Performed through Lower Lid
The answer is YES. Using a lower lid, blepharoplasty approach, the cheek fat ("SOOF") can be advanced and attached to the fibrous tissue on the lower orbit bone (called periosteum). This tends to improve the cheek fullness and the hollowing that occurs in many lower lids. This procedure is called a cheek lift or midface lift.
Vertical Lift of the Cheeks can be Achieved With a Midface Lift
Great question. What you are describing is a midface lift. In this procedure, small incisions are made on each side inside the upper lip, above the gumline which sits just below the cheek. A second tiny incision is made behind the hairline in each temple. The soft tissue of the cheek is freed up from the underlying cheek bone and it is suspended with the use of a dissolvable device called an Endotine. The vector of the lift is predominantly vertical in direction.
This midface lift can yield excellent, natural looking results as a stand-alone procedure or can be done in conjunction with facelift, eyelid surgery, or fat transfer. Midface descent is an often undertreated and unrecognized issue. I occasionally see patients who come to me after having had a prior lower facelift or necklift from another surgeon and they exhibit a Nike "Swoosh" look on the cheeks, with the jawline being tight but the midface sagging.
Seek a consultation with a facial plastic surgeon or plastic surgeon to determine if you would be a good candidate for this procedure.
Lifting Cheeks Vertically vs Horizontally
If you want to increase cheek projection the cheeks should be lifted vertically. The cheeks can be fixed in their new location using sutures or the Endotine fixation device. Alternatives to a cheek lift include fillers, fat injections, and cheek implants. You and your surgeon will select the best approach depending on your appearance and what you want to achieve.
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The mid-face area can be dealt with in a number of ways to create a "lifted" look
You are inquiring about the mid-face. This area of the face is tricky and can be dealt with in a number of ways from a lower blepharoplasty incision, intraoral incision with malar augmentation and with a facelift incision. If the patient is undergoing a combined blepharoplasty and facelift procedure, I will deal with the midface through both the lower blepharoplasty incision and the facelift incision. Through the lower blepharoplasty incision, I will often take down the orbitomalar ligament and perform a cheek lift, anchoring the cheek flap to the temporalis facia. Through the facelift or preauricular incision, I will dissect far enough anterior to allow for my SMAS elevation to continue from the more lateral part of the cheek to the more medial or 'apple' portion of the cheek, which creates an elevated midface. The combination of these two approaches results in a satisfying restoration of the midface profile. The lift vector is vertical. The skin is then redraped in an oblique vector that appears the most natural and avoids the 'cat-face' look.
Vertical cheek lift is the best way to lift the cheek.
Vertical cheek lift is the best way to lift the cheek in my opinion and I use the Endotine device to fix it to the bone. This way the vector is upward and lifts the sagging tissue in the opposite direction as gravity! Good thinking.
Vertical cheek lift
You are exactly right, in my opinion, that the descended aging cheek needs to be lifted straight vertically for optimal rejuvenation. That is my preferred vector in doing a facelift. Please check my photos on my web site for examples. The skin is then moved in a natural direction under minimal tension. Pulling the tissues diagonally toward the temple doesn't restore them in the direction from which they came so I don't do it that way.
There is also a cheek lift or midface lift which was developed to just address this area alone with a vertical vector but it is fraught with potential complications especially pulling the lower lid down because the tissues need to be suspended into the area around the eye.
Vertical face lift
Thank you for the question, what you are describing is mid face lift. With this procedure the cheek is lifted upward through a lower lid incision. If combined with fat advancement to the lower lid, the results will be better. You need to have a consultation with a plastic surgeon to address this questioning detail with you. Mid face lift is one part of upper face rejuvenation surgery.
You can lift the cheeks to where they use to be but it doesn't have to be a midface lift
IMO midface lifts are not a good procedure. They don't really do what you want them to do. There are new thoughts out there on how to rejuvenate people's faces in a younger and natural way. There are incision less face lift alternatives out there.
You are exactly right in what happens as we get older. In a youthful face, you can't tell where the eyelid ends and the cheek begins. Personally, I think adding volume to the under eye area and upper cheeks will help get you where you want to be.
This can be done with Restylane, Juvederm, and even fat transfer.
Lifting cheeks vertically
The best way to lift the cheeks is with volume augmentation. The cheeks sag because of volume reduction due to the aging process. Increasing volume in cheeks with cheek implants restore youthfulness, volume and lift at the same time. A simple vertical or horizontal lift will not look natural.