Flat cheeks and sad hanging under eyelids (Photo)

i have flat cheeks and hanging sad looking undereylids. I wish i would have a little bit more "almond eyes" or only be straight and also fuller cheeks. I had an an horrible op with slipping cheeck implants 20 years ago and already an eye and facelift. I'm sill unsatisfied and askes many doctors.All say something different.Mid face lift with an lift of the undereylid and fixing at the bone eye? or a "little" temporal lift to lift the both sides of the eye and filling my cheeks with radiesse ?

Doctor Answers 8

Get an in person facelift consultation

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Given the fact that you have already had multiple treatments to "turn back the clock", I wouldn't feel comfortable giving you a recommendation online. You really need to be assessed in person and have a frank conversation as to your desired outcome, and expectations. Schedule a consultation with a board certified plastic surgeon in your area to discuss the best options for your face.


Kouros Azar

Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 38 reviews

Sad Look

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You have a lot of mid-face laxity, which is best treated by a mid-face lift.  This will take out the tired, drawn look on your face.

It is best done through a lower blepharoplasty incision.  It is not corrected by conventional face lifting.  The shape of your eye can be adjusted at the same time.

Mid-face lifting is not carried out by all surgeons.  Many try to disguise the problem with volume augmentation.  For you lifting the mid-face would be a better option.

Douglas McGeorge, MBChB
Liverpool Plastic Surgeon

Combining Facial Procedures

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Yes, it is possible to #combine. In fact, I commonly recommend other procedures to go accompany a facelift, such as blepharoplasty or a midface (cheek) lift, to name a few. The combination of multiple of facial procedures may create an optimal result.

The best procedure approach will be discussed in greater detail during your one-on-one #consultation. I invite you to visit PacificCenterPlasticSurgery.com to view a complete list of surgeries commonly performed. 
The first step is to seek a board certified plastic surgeon who is highly trained with your desired procedures. I also encourage you to look at before and after photos of the surgeons actual patients. Also, reading patient reviews of those who have had combined surgeries will be beneficial. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

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Flat cheeks and sad hanging under eyelids

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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 are flat anteriorly (in the front), there is excess fat below the cheeks, jowls are present, the chin is weak, the Eyebrows are low, there is excess skin in the upper eyelids, excess fat bags in the lower eyelids with what looks like over filling of one lower eyelid and tear trough with a dermal filler.  These factors combine to create an elongated oval shaped face. 

 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.  Liposuction can be used to further shape the cheek area.

 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 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 and highly effective.

 "Jowls” 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 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
  • 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.

The Brows can be lifted with a Brow Lift which will make the eyes appear more "almond shaped" while the lower eyelid fat can be reduced with a lower Blepharoplasty.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Flat cheeks and hanging eyelids - what to do?

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Thank you for asking about your correction of your lower lid appearance.

I am so sorry you have had disappointing results from your previous surgery. This is a complex issue and requires a full examination to make any kind of recommendation.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Treatment of Flat Cheeks and Sad Hanging Under Eyelids

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After multiple procedures there is no way that anyone can advise you on this forum. You need a direct examination by a board certified facial rejuvenation expert who also has access to the operative reports from your previous procedures so an informed decision can be made.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Cheek volume helps support lower lids

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Hi Odalie. Sorry to hear about your previous surgery not going well. The best way to know is with an in-person examination to see how your tissue moves and how it changes with different expressions and movement.  I do agree that a filler into the cheeks will help your midface and the lid-cheek junction look fuller & smoother; and will provide some support to your lower eyelids-I prefer the product Juvederm Voluma for this.  This is a good option if you are interested in avoiding surgery.  There isn't a good nonsurgical alternative for the lower lids.  They would have a less "sad" look if you have them anchored to the bone-a procedure called a canthopexy.  Best wishes,


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Thank you for your question. The mid face lift, which may be include other surgeries (such as the undereyelid lift) is a more permanent approach to your desired aesthetic while using fillers is a more temporary approach. The most advanced filler is Voluma, which is identified further on my personal page here with the Voluma video. I suggest that you move forward and consult with a board certified facial plastic surgeon to determine if a facelift or a filler is right for you.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

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.