Are "tear troughs" and low flat cheeks are correctable with the details below?

Question

I am a 50 year old man who unfortunately always looks,not only tired,but to a degree,sick also.my cheeks,and also the area under my eyes which I believe are known as "Tear Troughs" (correct me if I am wrong) give a very unhealthy impression of me.I have always had low cheeks with with no real "Chub" for want of a better word.I am considering Cheek implants,Lower Blepharoplasty,and fat transfer/filler,possibly combined with a facelift (for excess skin),would this alleviate the problem?

Mehryar (Ray) Taban, MD, FACS · Answer

The best would be to combine lower eyelid surgery and cheek implants with the implant inserted through the inside eyelid approach which is very clean with no extra dissection. I have performed this many times. The implant would extended orbital rim (tear trough) implant which covers the under eye area along with cheek area. Need personal consultation to determine if you are a good candidate.

Jason Emer, MD · Answer

Yes, those are called tear troughs. A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Walton Montegut, MD · Answer

Your photos demonstrate the tear trough / malar deficiency [problem that occurs in the cheek area as we age.  I prefer to treat this area with fat transfer.  This is the latest technique and provides a long term and permanent result.  It also eliminates the use of a malar cheek implant which is a foreign body.  It is performed under local anesthesia and givers a great result.  Other surgeons may use the implant method but fat transfer is now preferred.  The other non surgical approach is Fillers but this needs to be repeated over and over.  My recommendation is fat transfer and you will get a great result.

Barry L. Eppley, MD, DMD · Answer

With the soft tissue and bone deficiency under your eyes, the best approach would infraorbital-malar augmentation of the bone. Because of the unique anatomy if this area there are no standard implants that exist in a united fashion for both area. This is best done by making custom infraorbital-malar implants to permanently fill in the depressed areas under your eyes out into your cheeks.

Sameer Bashey, MD · Answer

Your lid-cheek ratio is increased by the gradual fall of the cheek. This can be corrected with an filler that will also solve some of the tear trough issues at the same time. After this is done, a thinner filler can be placed in the tear trough to improve its appearance and get rid of the "tired" look of the eyes. Usually no more than 0.5 cc of filler needs to be placed per tear trough though you may need quite a bit more of cheek filler per cheek.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction, neck lifts and/or facelifts for over 30 years.  I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos your cheeks are flat in the front, there is excess fat in the lower face, jowls are present, the chin is weak as are the mandibular angles.  These factors combine to create an elongated, rectangular shaped face. 
 Following my beauty principles, men look chiseled and handsome with angularity in the cheeks, chin and mandibular angles.  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.  From the photos, your chin is weak.  A weak chin 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.
 It should be noted that fat injections (fat transfer) provides far less of a reliable and predictable volume to shape facial features than an off the shelf dermal filler or silastic facial implant (cheeks, chin and lips).  For this reason, I don not use fat to shape the cheeks, chin, lips or 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 from the face and neck
excess skin removed from the face and neck
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.
Hope this helps.

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