I am 33 years old and my face is beginning to get a droopy, tired look. I always had a kind of droopy expression but now I am also getting a deep nasolabial fold and jowels. It looks like my cheeks are dropping down, giving me also a dent in the cheek under the lid. I am considering a cheek lift, with incisions from the lower lid. How is that procedure done and where do I find an experienced surgeon?
Cheek Lift Procedure and Finding Experienced Surgeon?
Doctor Answers 9
Cheek or Midface Lift
Cheek or Midface lifts can be performed by many different methods. The "standard" or most common way that it is performed is by making an incision in the temporal hair line and elevating the tissues off the bone into the cheek. A lower lid incision may be added to elevate the tissues better. A stitch or absorbable devise is used to grab the cheek tissue, lift it up and tie or attach it to the temporal fascia.
I think this is making the procedure more difficult than it has to be. It puts the facial nerve at risk and more obvious incisions. In contract I make an upper lid incision (the same one used for an upper lid lift) and an incision inside the mouth. The mouth incision hides completely and gives me excellent visualization of the anatomy. The stitch is taken from the cheek tissues up to just behind the lateral orbital rim.
The benefits of this are: better, more well hidden scars, NO risk to the facial nerve, better tissue visualization and less interference with excess tissue. I've convinced many others to perform midface lifts in this fashion.
The cheek lift done through the lower eyelid has a lot of problems. I would stay away from that.
In New York, we do the cheek lift through the mouth. It is effective, leaves no visible scars, and I think would help you.
I don't know who is good at this in London. You should start by talking to several local plastic surgeon.
Cheek Lift and experienced surgeons
The operation has undergone multiple changes and permutations.
Although not the inventors, independently, Finger, a plastic surgeon in Savannah, Georgia and a group of plastic surgeons (Hester,Codner,Nahai) in Atlanta, Georgia popularized a VERTICAL MID FACE LIFT. The original procedures involved release of the cheek under the cheek bone lining (periosteum) through either a lower lid incision and possibly a mouth incision, with a tightening of the corner ligament of the eyelids and re suspension of the cheek via a suture(s) in the temple - The operation has been since modified multiple times to try and side step some of the complications involved with such steps.
At the present time, depending on who you ask, you will get a passionate defense on which cheek lift technique is "the" one to do. Obviously, as long as we have so many divergent points of view, there CANNOT be an obvious winner. Based on your picture alone, which is NOT sufficient for a real examination, I would suggest you may wish to seek a Plastic surgeon who is familiar with the Belgian Short Scar Face Lift (Dr's. Tonnard and Verpaele). These surgeons are across the Channel from you in Gent, Belgium.
The UK has a lot of talented surgeons, I would look through their respective professional society such as http://www.bapras.org.uk/ and interview several of them.
I hope this was helpful.
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Finding a Cheek Lift Plastic Surgeon
Nasolabial folds droopy face
Drooping and sagging
I would not do a lift through the lower lids to elevate the cheek. You have described all the problems for which face-lift surgery was developed and improved upon over the years. A good quality face-lift done under completely safe and comfortable oral sedation and local anesthesia will correct all these concerns totally naturally and for the next 10 years. The procedure you have asked about is done by very few surgeons and has more risk than a standard face-lift and results that are not nearly as good.
Do your homework!
We televised our technique using the Endotine device to the UK about 5 years ago. We think this is currently the best technique for the cheek lift. But you need to find a surgeon in your area who has a great deal of experience. If the surgeon does not perform it properly, you can end up with the eyelid pulled down.
Other alternatives for cheek lift
Perhaps one aspect you should consider is what has really changed in your facial appearance since your 20's. One key aspect that is seen in the facial aging process is the loss of mid-facial volume. As you lose volume, other characteristics become more prominent such as the nasolabial folds, marionette folds and jowls.
There is clearly an indication for a mid-facelift otherwise known as a cheek-lift, subperiosteal lift. In our own practice we use this to change the position or shape of the nasojugal groove as well as elevating the soft tissues of the cheek and correcting the lower lid aging effects.
However, typically with young patients, we restore volume first as this is the first thing usually that is lost. Think of if as the clothing you are wearing. If you lost 20lbs but did not change your clothing size it would hang on you unattractively. One option for correcting this would be to take in the clothing. Or, if you suddendly gained weight again the clothes would fit properly.
For those patients that liked their facial features when they were younger a useful first step is correcting the volume.
We prefer to do this with a technique known as fat injections, or fat grafting. This is typically done with just a local anesthetic and can restore the youthful features you once had. The short 1/2 procedure may answer your aging question and still leaves the mid-facelift as a future alternative.
Midface lift and the mechanism of facial aging
The cheek lift (midface lift) procedure is an ingenious procedure that introduced a revolution in the way we think about facial rejuvenation. A vertical descent of the cheek leading to deep nasolabial folds and a flat midface.
The recent advances in performing a midface lift came from my mentors in Atlanta Drs Hester, Nahai, McCord and Codner. Performing a cheek lift through the lower lid is not an easy procedure. A thorough knowledge of the anatomy of the lower lid and the various factors affecting lower lid malposition is essential prior to performing this procedure.
In your specific case a detailed exam by a well qualified plastic surgeon will give you all the options. If your lower lid does not show signs of aging, a cheek lift might not be the best procedure for you. Best of luck!
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.