Cheeklift and midface techniques
Basically, cheeklifts fall into several categories
1. Lower eyelid procedures. Full and minimal incision versions. Give the best results for the lower eyelid. Highest risk for lower eyelid problems unless they avoid the orbital septum (i.e. USIC, ultrashort incision cheeklift). Direction of pull tends to be straight up. Can be subperiosteal (more risky) or suborbicularis (less risky).
2. Through the mouth/temple. Direction of pull tends to be up and out. Often combined with Endotine device. Does little for the lower eyelid.
3. Fixation devices Primarily Endotine fixation devices. Can be done through incisions to the side of the eye (often visible), temple (can leave hair loss). Direction of pull tends to be straight up for side of the eye; up and out for temple approach.
4. Combined browlift / cheeklift technique, often through the mouth and through the temple, often with fixation device. Combinations of above procedures. Direction of pull up and out.
5. Through the facelift. If deep tissue restructuring is done (NOT conventional SMAS procedure), cheek tissue can be elevated. Many methods of this as well- subcutaneous vs. deep (i.e. Owsley, Hamra). A vital element of our facelifts. This aspect of the surgery cannot be performed any other way other than through facelift incisions.
Dr. Rand gives good advice on looking for the result, not the technique.
Every cheeklift is tailored to the patient's needs and anatomy.
The cheeklift is one of the most difficult procedures, so choose wisely. The rewards are great, avoiding change in eye shape while tightening the lower eyelids skin, avoiding redraping look of a facelift, very nice lower eyelid results, but risks also great if not properly done.
Your prospective doctor should be fluent with all these methods.
Below is a book chapter we published on the different types of cheeklifts in the textbook Mathes.
Cheeklifts are very tricky so look for an experienced cheeklift surgeon.
Dr. Moelleken has given a good summary of the many types of cheeklift procedures. Your question is excellent but any surgeon would need to see you in person to give you the best answer for you. The most common mistake I have seen in more than 30 years is that too much tension is placed on the eyelid and the lid is distorted creating an unnatural look. Also, the more that is done to free the cheek, the more chemosis(swelling of the lining of the eye) there is. Therefore, each of the methods should be discussed with your surgeon.
Without pictures it very difficult to give opinions as to what may or may not been required. The aging process is different for each individual patient and the surgical plan must be tailored accordingly. At 35 years of age, you a are most likely not having significant aging issues requiring a mini lift or facelift. The cheek area is best treated with an augmentation cheek implant rather than a vertical left to give a natural volume replacement to the cheek area. Fillers are also acceptable solution for a temporizing measure.
Cheek or Midface lifts: approaches and risks
Cheek (midface) lifts vary with incisions placed through the:
- Lower eyelid eyelashes
- Facelift incision
- Oral approach
Ideally, this will improve the hollowness of the tear trough, provide enhanced cheek fullness and some decrease in downturning of the corners of the mouth and diminution in the jowls.
Risks for all procedures include but are not limited to the possibility of infection, hematoma, wound breakdown, unfavorable scarring, overcorrection, undercorrection, asymmetry, loss of correction with recurrence, partial/complete sensory/motor nerve loss paresis or paralysis as well as the inability to provide any guarantees for a specific cosmetic result.
Risks that are specific for the above approaches include but are not limited to:
- Scalp: hair loss, wide scars, inadequate correction
- Eyelid: retraction, dry eye syndrome, ectropion,
- Facelift: lack of vertical lift, facial nerve injury
- Oral: upper lip numbness
Your surgeon can pick the cheek lift procedure best suited for you
There are many different cheeklift procedures. Some involve incisions on the lower eyelids with many different variations in how the tissues are manipulated and lifted through the eyelid incisions. Other cheeklift procedures involve incisions in the upper gum areas and the temples, and frequently utilize an endoscope (lighted telescope) to assist in the dissection.
All can be combined with other procedures such as face and necklift and browlift. If you have a hollowed appearance to your lower eyelids, then you would most likely benefit from a cheeklift performed through the lower eyelids with preservation and transfer of fat to fill out the sunken in areas at the juncture of the lower eyelids and the cheeks (the tear trough grooves).
Cheeklift performed through the lower eyelids has the potential for complications, including ectropion, which is pulling down of the lower eyelid. When done properly, the operation results in a smooth, youthful appearance for the lower eyelid- cheek transition with a natural fullness for the cheeks. Seek out an experienced plastic surgeon.
Cheeklifts fall into five catagories;
done as a part of a Facelift and are therefore done from the sides
done from a lower lid incision as a portion of a mid-face lift
done from the scalp above the ears
minimally invasive done with strings
liquid lifts - done by combining injections to get the look of a lift.
All these techniques can be mixed and matched to give the best results.
You need to see a surgeon who has an eclectic approach to the face.
Variety of cheek lift procedures
In my practice we offer a variety of facelift procedures customized to a patients wishes, down-time and anatomy.
The best answer will be based on your individual anatomy, and is determined during in-person consultation. The simple answer is that if you need loose neck treatment you are likely to be unhappy with a lesser facelift. In addition, if you have more than moderate jowls, you will get the best result with a standard facelift. The full facelift gives your plastic surgeon more ways in which to improve the many elements of facial aging.
Cheek lift or mini-facelift means a variety of things, however in my practice, we mean a procedure limited to the cheek, incision in front of the ear, less dissection and repositioning of facial laxity & fat. It has a shorter recovery and less discomfort. We do not use local or awake anesthesia, but we have the advantage of a board-certified MD anesthesiologist who will provide for your comfort during and after the procedure. A mini-facelift is a good idea for many patients. Many of them are younger and aren't yet ready for a standard facelift and want an earlier and more subtle improvement.
Cheek lift may mean also mean midface augmentation
There are several approaches to performing a cheek lift but, before you proceed it is important that you understand the objectives of the procedure you are looking to have. The cheek can either be lifted, augmented, repositioned, or all of the above. Mid-face lifts help to elevate the cheek to get rid of the infraorbital hollowing and to help better define a more youthful appearance to the face by repositioning your natural fat to the position it likely would have been found during youth. If you have always been deficient then your surgeon may suggest implants. One approach that you may want to consider in midface lifting and augmentation is the placement of filler or fat. In the right hands the results are fantastic and very natural appearing. All of these choices are available for discussion with an experienced surgeon.
Different cheek lift procedures
There are a wide variety of cheek lifting techniques. To find the best one for you, and in person evaluation is the best method to do this. Otherwise it would be too confusing to explain in any detail the +'s and -'s of each options. Regards.
There are really too many cheek lift techniques to give them justice here. There are "midface lifts" that produce a vertical lift of the central cheek and nasolabial fold and upper lip into the lower eyelid region. There are others that pull these tissues more laterally into the temple. Other surgeons (myself included) prefer to do the cheek part of a facelift for this area. I'd suggest you visit several qualified doctors and check their photos and see whose look the best to you. This would be more valuable than for you to try to sort this out based on technical details beyond what you could truly differentiate.