Dent in cheek after lower facelift - what are my treatment options? (Photo)

Question

The obvious dent in my cheek has not subsided with time. I massage it daily per my doctor’s recommendation. I have also had professional lymphatic drain massages. What are my options? I’m scared to do a revision surgery and come out looking worse. I’d like to avoid filler. I’ve read something about subcision but wouldn’t that involve a cut and scar in the center of my cheek? Thoughts on micro needling or ulttherapy? Cost is a factor for me but I don’t want to live with a dent either.

Tek Przylecki, MD, FACS · Answer

Hello and thank you for your question. Irregularities in skin and contour can occur after a face lift procedure and can have varying causes. Often these can improve or resolve over time. How long has it been since your surgery?One way to correct this would be through micro fat grafting. This can deliver more lasting/permanent results and for a small area like the cheek can often be performed under local analgesia, reducing the cost of the procedure. As always, I recommend you have a consultation with a board certified plastic surgeon and good luck!

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photographs.

Based on the appearance of the scars, my impression is that your facelift procedure was relatively recent. In many cases, the simple passage of time allows such concerns to resolve on their own. It’s also important to ask your surgeon whether the materials used to support your cheek tissue are absorbable or permanent, as this can influence the healing process.

Either way, it is likely that the depression will gradually fade over time and disappear without intervention. Subcision is a potential option if the depression persists, as it works to release the tension between the skin and the SMAS layer (the underlying muscle and tissue layer), which may be transmitting the pull. Subcision does not involve any cuts on the skin but is performed with a thick needle passed under the skin to release these attachments.

I would recommend waiting at least six months from your surgery before considering any corrective actions, including subcision. During this time, medications to reduce swelling around the affected area can be helpful. Massage techniques, such as lymphatic drainage, may also promote improvement by reducing swelling and encouraging healing.

I hope this information is helpful to you.

Jeffrey M. Darrow, MD · Answer

Thank you for your photographs. It appears from your earliest photograph that where the SMAS layer was plicated upward, the plication was not performed in a smooth fashion.  I believe the best way to improve this is to do a revision on that side where the SMAS can be resutured and smoothed to improve  your contour.  Your cost may be high on alternative therapies, which likely won’t be as effective but one directed at the exact cause of this would be the most effective. Best wishes.

John Michael Thomassen, MD · Answer

I would recommend a subsicion procedure where the skin flap is elevated and the tissue recontoured to correct the depression.  This can be done under local anesthesia in the office setting.

Michele A. Shermak, MD · Answer

Hello! Thank you for the question.
Have you discussed treatment for this with your plastic surgeon beyond massage and be patient? If you are within 6 months of your surgery massage and patience are very good recommendations. If you are beyond that, then a light filler in that area I believe would be your best option. Vollure in the Allergan line is perfect for this. Skinvive is another that would be great to try, but I think Vollure is better. Nanofat transfer is another nice option.
Best of luck to you!

Zoran Potparic, MD · Answer

Your dimples are most likely result of deep scars formed between the skin and deeper tissues after surgery. A surgical release of the scars with a needle or special fork cannula and injection of your own fat (fat grafting) will create significant improvement. In some cases procedure needs to be repeated if there is recurrent dimple. This is all done in local anesthesia.

Nelson Lee Novick, MD · Answer

I have been performing subcision for elevating and smoothing all kinds of Indentations, from all causes, since 1995. Unlike so many of the expensive, "bells and whistles" light, RF and other energy-based gizmos being hawked out there, subcision has a proven track record for safety and efficacy. Properly performed, the cutting in subcision is done, as its name clearly states, is done "sub," i.e. below the skin surface, as opposed to excisions and incisions, which involved cutting through the skin. Properly performed, by an experienced, board certified cosmetic dermatologist expert, once the needle or cannula is withdrawn, it leaves a temporary mark, the way a blood-drawing needle does. 
Microneedling, which I have been performing for over 23 years is best reserved for treating superficial color and texture Irregularities; it would be very unlikely to be of much use in this kind of problem. And revision surgery (even disregarding its expense and post-treatment downtime), particularly in areas subject to a great deal of movement, runs the risk for the subsequent development of stretch scars and even tram track stitch marks. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist with extensive experience in performing subcisions. Best of luck.

Darryl J. Blinski, MD · Answer

Based on your nicely posted photos, the treatment I would offer for this area would be the Endo technique with micro crafting. Fee $5000. Best of virtual consult with.

Dent in cheek after lower facelift - what are my treatment options? (Photo)

Answers (8)

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