Initial face & neck lift done in '09. Researching for revision. High smas to address indentation over cheek bone? (Photos)

From what I understand, a smas lift will address the jowls but will a "high" smas lift address the indentations that I have directly over my cheek bone from the frontal view or what I would call the apple of my cheek (mid face)? Sorry for upside down photos. Thank you!

Doctor Answers 9

Treatment Options for the Lower Face

During your #consultation, your skin texture and elasticity, as well as your underlying skin structure and your facial bone structure will be evaluated. Based on this evaluation, your board certified plastic surgeons will create a custom surgical plan, detailing specific techniques and recommendations to meet your goals. In doing so, he or she should be sure to have a full understanding of what results you expect.

If you are not a #candidate, your surgeon can make other suggestions to address your concerns and objectives.
Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
The best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic may also be a candidate for a Lite Lift™.

It is also possible to #combine #surgeries. 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.

Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews


It appears to me that a lower facelift would be adequate to address your jowls and neckline. You seem to have good volume at your cheeks and I would need to look very closely at the indentations you're talking about.  There is a chance they are due to an Lymphatic blockage in that area or perhaps loss of cheek fat. Likely they can be addressed with fat or fillers.
 As far as a high SMAS lift goes, if you had a smas lift in 09 I would not do it again! There are other techniques that will be safer for you at this point.
Good luck! 

Mark T. Boschert, MD
Saint Louis Plastic Surgeon
4.9 out of 5 stars 30 reviews

Revision facelift

A revision facelift would help the lower face and neck areas. The cheek indentation (midcheek furrow) would likely not improve greatly with a lift alone but may improve with filling that area directly and carefully with fat or synthetic fillers such as Restylane. The swelling in the cheek area above the indentation might be improved with conservative laser resurfacing to tighten the skin, but know that it is a challenging thing to get perfect. 
I hope that is helpful and best wishes, 
Dr. Donath

Alexander Donath, MD, FACS
Cincinnati Facial Plastic Surgeon
4.8 out of 5 stars 37 reviews

Candidacy for revision facelift

You have a few issues.   Revision facelift surgery with a high smas procedure can enhance your mid face and areas of hollowing.  Fat grafting  and filler can be added to further camouflage any persistent countour deformities.    Your malar edema will not be improved with the facelift and can be difficult to get rid of. Micro needling and lasers may be helpful in improving malar bags in certain situations.  

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.3 out of 5 stars 93 reviews

Facelifting #woundhealing #cosmeticsurgery #BOTOX

Dear Adultchild

Thank you for your question!  The indentations appear to be from the Malar lymphatic outflow- I am not sure that they will be improved with surgery.

With Warm Regards

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 115 reviews

Revision facelift

You are a good candidate for a revision face and neck lift with small amount of fat grafting in malar area to improve the groove on your cheeks. These procedures can be performed with local anesthesia and twilight sedation.

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
4.9 out of 5 stars 204 reviews

Malar Bags are the Problem

You have malar bags which are giving you puffiness over your cheekbones. The dents you refer to are where the lower part of the malar bag meets the cheek. Treatment of this problem by means of fat injection is not particularly effective, in my experience. Diuretics are of some help in that they decrease the fullness of the malar bag.

As far as a facelift is concerned, a traditional SMAS Lift will improve your jowls - a high SMAS Lift is not required for jowl improvement.

George Sanders, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 12 reviews

Revision facelift and indention over cheek bone

Based on your pictures you would be a perfect patient for my composite facelift which includes a cheeklift/lower blepharoplasty. The strongest lift is moving the skin upwards, toward the eye. The cheekfat is preserved and and re-positioned. Once the cheek mass is re-positioned it will then resemble the high cheek mass of a youthful person. With the jowls, a plastic surgeon needs to address the deeper tissues. Instead of stretching the skin, they need to re-position what is underneath. It turns the jowls into a tightened jawline that stays youthful. Make sure you see a board certified plastic surgeon that specializes in facelift revisions. Good Luck.

Sam T. Hamra, MD
Dallas Plastic Surgeon
4.8 out of 5 stars 12 reviews

Face lift and fat grafts

You are a good candidate for a face/neck lift. A groove due to separation of fat compartments in your cheeks is not going to be significantly corrected with SMAS manipulation. However, use of fat grafts to fill this space will help. This can be done as a part of face lift surgery or as a separate procedure.

You should consult an experienced board certified plastic surgeon in your area and discuss your options. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 17 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.