Q: Dr. Eppley, I am 48 years old and have lost about 60 lbs over the past year with diet and exercise. I am now three months from a facelift and neck lift. While my face did improve, I haven’t seen the results that I was expecting. I still have a round face. I was expecting a sharp cheek shape and sharp definition of jaw line. There’s still loose skin in mid face which I was hoping that a face ift would address. I understand that there is still swelling in lateral mid face and and around jaw line. My very specific goal prior to face lift was to get rid of double chin, which I still have. I also wanted to have the buccal fad pads removed which the surgeon determined intraoperatively that it was not necessary. My surgeon said that he can do redo the liposuction of neck and face. I also had lower transconjunctival blepharoplasty, which improved the bags. However, I still have residual bags. He said he took out minimal fat to avoid sunken eyes which I agree. However, I still don’t like the residual eye bags. He said he can now remove the buccal fat pads and also perform subcutaneous midface liposuction along with fat grafting around the cheeks to create a prominence and blend into the eye bags. He mentioned that cheek implants are out of favor now as it is difficult to achieve bilateral symmetry and they have a high incidence of nerve impingement at inferior orbital canal. He also has offered to tighten the facial skin. He said the SMAS and platysma muscles have been maximally tightened and there is no room to further tighten it.
I am just very confused as to what should be best approach to address my facial reshaping goals. I was very happy to come across your reviews as you specifically address men’s faces.
A: Thank you for providing all of the pictures and your more recent surgical history. From this information I can make the following comments:
1) No form of a facelift/necklift is going to create a more defined facial skeletal structure. Without adding volume to the cheeks or jawline their appearance is not going to be enhanced.
2) In looking at the pattern of the incisions for your face (which are often appropriate for some men) the effect of the lower facelift/necklift is going to be limited. Limited incision means limited results in many cases. The good outcome from that approach is that the incisions will be well hidden and will not create any secondary aesthetic issues. The bad news from that approach is that the neck will be left with some excessive tissue and the midface tissues will not change. The double chin can only be improved by a platysmaplasty and incisions on the back of the ear that allow for more tissue rotation.
3) A transconjunctival lower blepharoplasty can not create optimal correction of your lower eye bags. This requires a subciliary external incisional technique.
4) Fat grafting will not create any lasting cheek augmentation effect in your type of tissues. And even if it could it would create a rounded effect not an angular effect. Only a cheek implant can create that more defined cheek look.
5) Cheek implants have not fallen out of favor. They are used more today than ever before and they do not cause infraorbital nerve problems or a high risk of asymmetry when well placed. It is true that many plastic surgeons rush to use fat grafting because it is simpler and requires less surgical skill and experience over any form of facial implants. And for many patients this is more appealing and is easier to accept. But for cheek augmentation in men in particular fat grafting does not create the same effect as cheek implants.
Dr. Barry Eppley