Cheek Pad Repositioning During Facelift or Neck Lift?

Are the cheek pads always respositioned without being undermined when a person has a lower facelift and neck lift? Or is this a technique that only certain doctors use? Thank you.

Doctor Answers 9

Cheek Pad Manipulation in Facelift & Neck Lift

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Hi Brooke,

This is a great question. Not all facelifts are equivalent. Many minimally invasive facelifts, which are marketed as quick, in-office procedures done under local anesthesia, do not involve significant manipulation of the deeper tissues of the face. This layer, which is called the SMAS (superficial musculoaponeurotic system), makes up the bulk of the fat and muscle of the face. Procedures which do not involve some manipulation of this layer tend not to have long-lasting results.

Most board-certified plastic surgeons and facial plastic surgeons choose to reposition the SMAS layer in some manner. Different surgeons manipulate this layer in different ways; some plicate it (sew it to itself), some remove a strip of it and sew it back together, and others completely lift it up and reposition it entirely. There is no one way to achieve the best results - it largely depends on your anatomy, as well as the skill and experience of your surgeon. There is also a cheek fat pad, called the buccal fat pad. This is located deep to the SMAS. Some surgeons choose to reposition this, and in some patients with particularly full cheeks, this fat pad can be partially removed.

Hope this helps. Best of luck.

Facelift: Midface, Jowl, and Neck Elevation

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When explaining the term Facelift to patients, I generally describe the procedure as a mid face, jowl, and neck elevation. In my hands, the "vector of pull" of the jowl and mid face will be vertical, thereby raising and providing more volume to the mid face. The "vector of pull" in the neck is generally posterior (back). I find that there is a great deal of synergy to mid facial enhancement when lower eyelid Blepharoplasty is performed at the same time.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Cheek pads are repositioned during comprehensive face/neck lift

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The cheek pads are usually repositioned with a traditional face/neck lift so as to resuspend them back up into their normal anatomical position. This is the normal course for a comprehensive face/neck lift.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Cheek pad repositioning.

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Fullness of the upper midface MEANS a youthful look. So in one way or another, a good facelift will lift the cheek pads to create this fullness.  But there are several different techniques to do this.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Cheek pad repositioning during facelift or neck lift?

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Hi Brooke,

Are the "cheek pads always respositioned" ? No, They are not.

A Facelift is a very generic term with little specific meaning. It describes facial procedures intended to reverse facial descent.

But, because face lifts can be done at several anatomical levels, each with specific ways of lifting and tightening, there are many Facelift techniques with multiple ways to undermine and lift the sagging face. Not all of them accomplish reversal of all facial aging. Some techniques do not go too far forward - as result they cannot lift sagging jowls, cheek fat (inc SOOF) etc.

Personally, having used most of these techniques I think the "best" technique is the Facelift method which will address YOUR concerns. IF you wish/need more central lifting, you will need to have a Facelift technique which lifts these areas.

Talk it over with your Plastic surgeon. Explain your concerns and wishes. Ask him/her what methods would take care of these issues.

Good Luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Cheek Pad Repositioning

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"Facelift" is a very generic term. There are many ways to do this surgery. Most of us will use different techniques , so the procedure is individualized  to meet the needs of each  patient. Repositioning the cheek fat is done when indicated.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Cheekpads are always repositioned to some degree

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Dear Brooke

Cheek pad repostioning means very different thing to different surgeons. You can be sure that when there are a lot of really different ways of doing something, no one approach is best.

There are many maneuvers that are done in an effort to reposition the cheek fat pad. Some are ok and some are, to be kind, unnatural. I think that there is general agreement that over time the cheek or malar fat pad falls. What to do about this is an other matter. I am of the school that most of what makes the under eye circle and jowl is the descent of the malar fat pad. However this pad falls mostly vertically, very little of this fall is from sagging of the face from the side.

Why is it important how the face sags you might ask? The answer is that we operate passed on our theories. If a theory is not correct, well then it is likely that the surgery will also not be right. I have a vertical midface lift that I use to address the fall in the malar fat. This surgery is performed through the eyelid. However, many surgeons attempt to lift the cheek fat pad through the facelift incision or throught an incision above the ear which may or may not be part of the facelift incision. This is a so-called temporal midface lift. The problem with this approach is that the dissection pathway from the temple damages the fat in the way of the dissection. After surgery the cheek fat is pulled to a place that looks unnatural and often it looks like a bit has been taken out of the bony rim of the eye socket.

Originally surgeons also attempted to pull the cheek fat pad to the side of the face using a composite facelift in an effort to flatten the nasolabial fold. This is a very unnatural effect that results in permanent facial disfigurement.

The moral of the story is that you really need to pick your surgeon not your procedure. Consult with surgeons and attempt to assay if they make sense to you, do they answer you questions, are they kind, and do you like their work. This will help you find someone who is right for you.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Cheek pad elevation with some Facelifts

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The only lower facelift that will elevate your cheeks (mid-face lift) is called the deep plane facelift. This is a technical name for a facelift technique (as opposed to a marketing term). In addition ot improving your neck and your jowl / jaw-line, the deep plane facelift will elevate your cheek pads as well.

If cheek elevation is all you are looking for, then a mid-face lift may be a better option.

Jacob D. Steiger, MD
Boca Raton Facial Plastic Surgeon
4.9 out of 5 stars 71 reviews

Direct methods for Cheek Pad Repositioning

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The procedure that is most effective for addressing the cheek pad is a Mid-face Lift, as that procedure directly moves the cheek mass.  Certain versions of Face Lift procedures also move the cheek mass, but not as effectively as a Mid-face lift.  Finally, a true isolated Neck Lift will have no effect on the cheek mass.  Whichever surgeons you visit, discuss your desired changes by pointing to regions of your face and emulate the movements that you wish to achieve - let them tell you how they will do it (and what name they give the procedure...)
Dr. B

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.