What can a plastic surgeon do to prevent ectropion resulting from a vertical cheek lift (lower eyelid incision)?

I have had a lower face lift that did not address my descending malar fat pads and deepening tear troughs. I want a cheek lift to restore my tissues to their previous positions. I do not want to camouflage my midface aging problems with facial fillers. (However, I am willing to undergo fat grafting after the surgery as an adjunct to increase my anterior cheek projection.) I want the longest lasting result. Downtime or bruising are not an issue. Please advise.

Doctor Answers 2

Thrue cheek lift

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It is possible to achieve permanent cheek lift providing that one can anchor lifted tissue in a stable position. This is in our practice achieved by drilling 2-3 small holes along lower orbital rim and using it  to anchor cheek/malar pad. This provides more skin to the lower lid and prevents ectropion. Additional procedures such as lower blepharoplasty (conservative removal of lower eyelid skin, if necessary) and canthopexy (to tighten the eyelid) are done in the same time. Consultation with an experienced board certified plastic surgeon with extensive experience in facial reanimation and periorbital/eyelid surgery to discuss your goals and options would help.

Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

Facelift that goes deeper into the facial tissue plus fat transfer is known for its lasting effect

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Malar fat pads are best addressed by SMAS and deep plane lift--in layman's term, we must go deeper beyond the skin.  Skin lift is an antiquated technique that great surgeons have long abandoned due to its short-lived result, unnatural appearance (flatness of the cheek and overly tight appearance), and poor scarring. 

I also typically combine facelift with fat transfer to hide the laugh lines and create a smooth transition between the lower lid and upper cheek.  The truth is, fat transfer is a highly flexible and useful procedure as it can also correct the appearance of pre-jowl sulcus (the sagging tissue adjacent to the chin and along the jawline) and the depression of the temple.

Simply put, long-lasting and natural results (average of 12-15 years) are achieved when we go deeper into the facial muscle and tissue and at the same time address facial volume loss preferably with the most natural material--your own fat. 

Good luck and best wishes. 

Tarick K. Smiley, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 117 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.