Can a mid-face lift be done on a 32yo M who already has custom PEEK cheek implants to address chipmunk cheeks (jowls)? (Photo)

Had Congenital Mandibular Hypoplasia- bi-max & custom PEEK Jaw angles & Cheek Implants with buccal fat removal done 1.5 yr ago. Now have chipmunk cheeks-round face. Attached is 3D model of actual KLS Martin Custom PEEK implant positions. Am I suitable for Endotine Mid-face lift? My concern is whether soft tissue will reattach to the PEEK Cheek implants once vertically lifted? Alternatively, is there anyway that malar fat pads can be lifted (suspended) in place without full face lift?

Doctor Answers 3

Midface Lift After Cheek Implants: Options for Treatment

A midface lift will elevate the cheek and malar region to help eliminate sagging tissue in this region. Cheek implants are typically placed in the subperiosteal plane and because of the numerous tissue planes in this region, the more superficial tissue could slide down over the implants. 

The analogy would be in breast surgery where an implant alone is placed only in a patient who needs both an implant and a breast lift.

A subcutaneous midface lift could easily be performed over the cheek implants with the goal of staying away for the implant plane and providing an effecting release of the malar tissues and reposition the orbicularis upwards. Enodtines would likely not be recommended as they would need to seat on the periosteum of the malar bone. Sutrue fixation only would be all that would be needed for this light subcutaneous flap.

Austin Plastic Surgeon
4.9 out of 5 stars 24 reviews

Custom PEEK Jaw angles & Cheek Implants with buccal fat removal done 1.5 yr ago. Now have chipmunk cheeks-round face.

 Hi, non smiling photos of your face from the front and side would help with the evaluation. I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years. Following the beauty principles outlined in my book on face and body beauty, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.

 Cheek augmentation with a dermal filler or using properly, sized shaped and placed cheek implants for a permanent enhancement will create a more angular cheek(s) and face.  From the 3'D scan the cheeks are full and round in the front of the cheeks will creates a softer, rounder cheek and a heart shaped face which is a feminine cheek and facial characteristic.  

The following procedures would create a more ruggedly handsome face.

  • Cheek augmentation with cheek implants to add angularity to the cheeks and mid face.  This would be combined with liposuction to reduce the excess facial fat to further define the cheek shape.
  • Chin augmentation, using a chin implant, to add projection to the chin creating harmony and balance to the lower face.  I have performed many Chin Augmentations using chin implants for over 30 years.  If 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, highly effective and far less invasive than a sliding genioplasty.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.
  • Augmentation of the mandibular angles using a dermal filler (jaw implants have too many unwanted side effects IMHO) to add volume, angularity and flare to the jaw line.

 If you have "jowls” these 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.

Think of facial beauty as something that "must" address all layers of the face including the skeletal structure of the cheeks and chin, the overlying SMAS muscle, amount and position of subcutaneous fat and finally the degree of skin laxity. It's an "urban myth" that pulling tissues over flat cheeks and a weak chin can create a beautiful or handsome face. Similarly, dermal fillers or facial implants alone can't lift and remove excess skin from the face and neck. Natural looking beauty is created by the aesthetic vision of what tissue layers need to be adjusted by what technique and amount.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Facelift #faceliftrecovery #fatgrafting #beauty #tmbcosmeticsurgery #woundhealing

Dear DamIt85

Thank you for your question!  Facial shaping can only be partially corrected with "lifting".  Endoscopic lifts basicall deglove the facial tissue. Assuming that the endotine fixation can hold the tissues - and not the implants- then hopefully the malar fat pad will remain where it is "pulled " to against the effect of gravity.

With Warm Regards

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 102 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.