What would be best for my problem? Significant midface deficiency (Photos)

Question

I had Lefort 1 upper jaw surgery couple years ago because I was born with a very recessed maxilla and had a bad underbite. I realize now I still have that sunken in, flat, sad look when face is neutral. So I would like my upper maxilla above the Lefort 1 line to appear flush with cheekbones thus hopefully removing the downward shadow lines gap that is present. I roughly present what I would want. I believe my best route would be submalar implants. For implants, which material lasts best?

Zoran Potparic, MD · Answer

Based on your photos it appears that cheek augmentation with implants, possibly addition of fat grafts is your best option. Silicone implants are used most frequently for this purpose. You should consult an experienced board certified plastic surgeon with good reputation in facial implants to discuss your options. Good luck.

Jason Emer, MD · Answer

Facial symmetry and volume of the cheeks can be created with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra. This would let you try on the look before committing to a permanent option. Implants or fat are alternatives. Implants can be customized to desired results. With fat transfer, harvesting is important for successful fat transfer. I use gentle water-assisted harvesting to get the most viable fat to transfer. I combine with prp and sculptra to improve results. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Toby Mayer, MD · Answer

Silicone (solid) implants will give you what you want if done by a very experienced surgeon. These come in many sizes which should be chosen by you and your surgeon. This is a permanent solution and does not have the variability of fat.

Zein E. Obagi, MD · Answer

You may eventually decide to have an implant but that is surgery. Why not see what the area would look like with cheek filler such as Voluma first?

Chase Lay, MD · Answer

Submalar seems like a logical move.  You should also explore mid-face implants and/or fat transfer.  Silicon would be my choice of material.  I'd start with Dr. William Binder, Dr. Jonathan Sykes, or Drs. David Lieberman and Sachin Parikh.Chase Lay MD

Sean Freeman, MD · Answer

jj10sa, Cheek implants are very useful for patients with inadequate 3-D volume, mid-face fat atrophy and/or both of the above. I find that the results I obtain with cheek implants are predictable and patient satisfaction is high. Tear trough implants are not in that category. the skin in this part of the face is much thinner and the implant boundaries can be visible at times. A much better approach to this problem is to use a SOOF lift blepharoplasty. As the originator of the SOOF lift blepharoplasty I can tell you that in my opinion this is the best procedure for improving the hollow look under the eyes that accompanies the aging process. I've been doing nothing but this procedure since I originally published this approach around 1999 in the Archives of Facial Plastic Surgery. The reason this approach works so well is that by doing this the patient's anatomy is returned to what it used to be when they were younger yielding natural looking results with little morbidity.  Look at as many pre and post op photos of the surgeon you are interested in seeing as possible and make sure you like the results. Seek more than one opinion and see someone who performs the procedure you are interested in routinely. Preferably someone who specializes in facial aesthetic procedures.

Walton Montegut, MD · Answer

Good Question.  You have several options. Fat transfer would be the option I would choose for this problem.  This is utilizing your own body fat and layering it in the cheek and midface area to fill the deficient area with the necessary volume for replacement.  This is a long term result and remains with you as you age.  The fat is removed from one area and centrifuged and then injected into the area and contoured to your cheek.  There is no chance of rejection and it will give you a wonderful result.  The other option is the standard cheek implant.  This choice has been the customary approach for many years.  The implants are silicone based and provide a structural support for the area.  The implants come in many sizes and shapes and can be carved to shape the area.  It is a foreign body long term there can be problems with the implants such as malposition, etc.  I prefer the fat transfer technique for facial shaping.  I have not used implants in the face in a very long time.  Your own fat gives the best result, and there is no chance of rejection or malposition.  The procedure is performed under local anesthesia with minimal downtime and recovery.  God Luck.

William Portuese, MD · Answer

When patients have a mid-face deficiency, consider cheek and plans to augment the maxilla. Cheek implants are manufactured in a large variety of sizes and shapes, which is best determined time of the consultation and revelation, since both the maxilla and the implants are three-dimensional structures. Cheek implants are composed of  solid silicone, and can be custom carved when necessary to match patient's unique anatomy. In our practice, we placed cheek implants through intraoral approach under brief general anesthesia as an outpatient surgical procedure. For more information in many before-and-after examples including diagrams of the implants themselves, please see the link and the video below

Arian Mowlavi, MD, FACS (license on probation) · Answer

Your facial proportions can be improved with more facial filling over the central cheek region as well as decreasing the prominence of your nasal dorsum; the latter will bring the illusion that your cheeks (mid face) is fuller as well; for cheek filling I recommend fat grafting which provides the most ideal and permanent fix.

Richard W. Fleming, MD (retired) · Answer

Fat or a long acting filler such as Voluma or Restylane Lyft could be injected to augment your cheek but my first choice would bee silicone implant which would be a permanent solution to your problem. Consult with an experienced surgeon to evaluate you and discuss your options.

What would be best for my problem? Significant midface deficiency (Photos)

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