Do you think I would benefit from a mid face or cheek lift? I have Malar bags and mid face sagging. (Photo)

Question

I have developed malar bags and mid face sagging. I am 44 years old. I have tried fillers and botox but they make my cheeks heavier and I would prefer something more permanent. I am also being treated for a chronic sinus infection, deviated septum, and enlarged turbinates so I know I need to have these addressed first. Would I benefit from a mid face or cheek lift for a fresher appearance? Thank you for any advice

Philip J. Miller, MD, FACS · Answer

I would recommend volume enhancement using a number of techniques ranging from fat to synthetic fillers which will help symmetry. Once facial aging progresses to skin laxity and dissent, I recommend a micro or many facelift. I actually have found that patients who get treated surgically sooner end up looking better longer.
Sincerely, 
Philip J. Miller, MD, FACS
Double Board Certified Facial Plastic Surgeon

Sam Speron, MD, FACS · Answer

A Mid face or cheek lift Facelift can usually be an option on most realistic patients anytime after the age of 35-40. It really depends on your anatomy and genetics. It is best to talk to your surgeon because everybody has different techniques and recovery time is usually based on a number of factors. If we are just talking about a short scar or midface lift, this can typically be done in the office under local anesthesia. Usually there are no drains, no outside stitches, and patients can go out in public the same day, although I usually recommend they low for the first couple days. Most of the initial swelling is from the numbing medicine and your body absorbs it within the first 4-6 hours. Obviously the body heals with swelling and inflammation and usually that maxes out at two days and then starts getting better. Most of these patients take no pain medicine and usually feel very comfortable going out in public within a few days.  I usually call my patients the night of surgery and check on them the next day. If everything is fine the next day, I then let them shower and they do not need a dressing over their incisions. They can usually start using make up after a few days.  At the two week check up, I usually have people start working out and then after six weeks they can do whatever they want. I routinely tell people to take a few days to a week off work and to hide out but some people are very nervous especially celebrities and I usually tell them to hide out for two weeks. As with any scar on the human body, initially scars are red, hard and raised and it typically takes six months to a year for them to become a soft thin white line. Additionally with recovery, there're many things we do to expedite healing such as nerve blocks during surgery, oral supplements, skin care and scar therapy recommendations, lymphatic massage sessions that are included in our pricing.I strongly feel that it's very important to have an honest conversation with your surgeon about your particular situation, lifestyle, work environment and specifically which procedures you're having done so that you both have the most honest answer about your recovery and are realistic with expectations and results.Surgery is not for everyone. In today's day and age, there are many nonsurgical options to consider although surgery usually gets the most improvement specifically of the jowls.I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of facelifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations. I hope this helps and wish you all the best in your surgery and event. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Steven H. Wiener, MD · Answer

Thank you for your question and photos.  You appear to have some mid-face volume loss and ptosis.  Also moderate jowling and neck laxity.  I would recommend a full face lift with fat transfer to your mid-face and malar areas.  This will give you long lasting improvement.

Jonathan Kulbersh, MD · Answer

A significant degree of sagging is best remedied with a full rhytidectomy (facelift) which will have long lasting results. With volume loss in the mid face, this can be improved with fat grafting done during the facelift which can also help asymmetry. I do recommend a neck lift with platysmaplasty to fix any sagging of the chin and neck, plus a chemical peel to improve the wrinkling and stimulate the production of new collagen. Microneedling could help improve the scars. I hope this helps!

Gilbert Lee, MD · Answer

Thank you for your question and pictures. There are multiple factors that contribute to facial aging. One is fat loss. As we age, we lose fat in our faces which causes a hollowed out look under the eyes and allows the skin to sag. Another factor is sun exposure. It destroys the structural component of our skin and causes discoloration and pigment changes. When rejuvenating the face, it is best to take all of these problems into account. Fat grafting can add volume to depleted areas bringing a youthful appearance back to the face. In our office, we perform the fat grafting in conjunction with our rapid facelift and necklift. This is done in the office with local anesthetic. The patients walk out of the office feeling great and recover quickly. We also offer 3D imaging to give our patients and accurate idea of what their final result will look like. Good luck!

Julie Edween, DO · Answer

Mary Loughran,To address you malaria bags and mid facial descent, restoring and replacing volume in this area would be improved by a mid face lift and volume restoration with fat injections.  However, you do have some some skin laxity in your neck and jowl area, and you may want to consider rejuvenating these areas at the same time with a full facelift surgery with fat transfer to restore the volume loss in your mid face and cheek area.  Best of luck!Dr. Julie Edween

Lourdes Rodriguez, MD · Answer

Hello, thank you for your question.

As i can see on your pitctures your would benefit of a facelift, where we can treat the middle and inferior third of the face, to get a better result we need to combine it with a superior and inferior eye lid. With your skin laxity the result would be very good and would return the youthnessu that we lose with the years. Remember to choose a board certified plastic surgeon. Best of lucks!

Raghu Athre, MD · Answer

What I see....I see a prominent tear trough, loss of volume of the midface, ptosis/drooping of the midface extending into the jowl region, and laxity in the neck.I would....1. Face lift with resuspension of midface, and neck2.  Fat transfer/volume addition to under eye and midfaceand possible address skin with laser vs TCA peel

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos your cheeks are concave in the front, there are signs of "malar bags" on the cheeks, jowls are present and the chin is very weak.  These factors combine to create a, long, thin, rectangular-shaped face.  The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
 In my experience when evaluating the face, it's key to determine the following:  Are the cheeks, chin and lips the ideal aesthetic shape?  Are "jowls" present and is there excess fat and skin in the face and neck.  Once these factors are determined, the proper aesthetic plan can be determined to make the face balanced, (for women) feminine and more naturally youthful and beautiful (while for men creating a more chiseled, angular and handsome face).
 Nasolabial folds are caused by two factors:  1. When there is an excess amount of mid face fat, gravity pulls the fat layer towards the nose and mouth with aging to create nasolabial folds and jowls.  2. Another significant contributing factor is the presence or absence of sufficient cheek bone volume in the front of the cheeks and face to support the cheek tissues.  When the front portion of the cheeks are flat or concave, this lack of bony support allows the cheek tissues to sag off of the cheeks towards the nose and mouth creating nasolabial folds and jowls.  Often both factors are at play when significant nasolabial folds are present in the face.
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  When the cheeks are concave or flat in the front, cheek augmentation with a dermal filler or using silastic cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  The dermal filler can also be used to soften the edges of the malar bags as there is "no" treatment to remove them.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
proper SMAS Imbrication technique
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
Hope this helps.

Do you think I would benefit from a mid face or cheek lift? I have Malar bags and mid face sagging. (Photo)

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