51 & don't like my fat wrinkly cheeks, my hollow eyes with sagging malar crescents. What can be done to improve these? (Photos)

1. I have noticed lines/ wrinkles on my cheeks when I smile. photos 3&4. I had a lower face lift and fractionated CO2 last February. photo 1. I subsequently had IPL and dye laser treatments. I am using Retinol.Had botox & filler. 2. My lower cheeks look fat to me. photo 6. what would you suggest to thin them. 3. I have hollows under my eyes, and I don't like the sagging malar crescents. 4. Would a chin implant help balance my face?

Doctor Answers 1

Don't like my fat wrinkly cheeks

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 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  From the photos your cheeks have a significant amount of fat around them, the indentation typically represents a line of separation or sagging of this excess fat off of the cheek bone.  The chin is weak as you have mentioned.  I shape the cheeks, chin and jaw line (if needed) with every facelift as described below.  Since you have already had a facelift, cheek augmentation and shaping with liposuction to remove the excess fat followed by either cheek implants or a precisely placed dermal filler might be considered.

 Following the beauty principles outlined in my book on face and body beauty, 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.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

 A weak chin 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 that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.

 The following is a description of a minimally invasive SMAS facelift that combines shaping of the face for comparison.  If you have "jowls” these are sagging facial tissues and an 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 facelift is the minimally invasive, short incision 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
  • 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
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • 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.

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