Cheekbone Reduction and Midface Sag

Q: Dr. Eppley, I have some cheekbone reduction questions. I’m already quite dissatisfied with the droopiness of the lower third of my face and along my jaw. Hence, I’m extremely worried that the cheekbone reduction would further worsen this droopy look. I’m sure you’ve heard about the “falling tent without its support” metaphor, to describe what happens to the surrounding skin when the cheekbone is reduced. I’m hoping to gain a more balanced midface without this happening.

While you mentioned that I may be too young for any lifting, I would be very interested in any lifting/liposuction procedures to effectively ameliorate the droopiness that I’m seeing, both in my midface and my neck area.

A: Any time you disrupt the attachments of the cheek, there is always the risk of some soft tissue sag. As I stated in my prior email this has not been an issue that I have seen from cheekbone reductions due to fixation of the osteotomized bone segments in their correct anatomic position. But that being said, the only way to have zero risk of that not happening is to not have the procedure.

When I mentioned that you are too young for any lifting procedure, it is important that you understand what I mean by that statement. All facial lifting procedures have as their origin the treatment of tissues that have dropped or sagged due to aging. Thus there is tissue laxity by which they can be moved. Young people, however, do not have any tissue laxity and thus any true lifting procedure can not really be done. You can not move someone’s tissues into a ‘super normal’ anatomic position. While it is possible to re-establish normal tissue positions AFTER they have dropped, you can’t really lift tissues that have not dropped. In addition, and equally importantly, any effective lifting procedures require scars. In the midface that is going to be eyelid, temporal or both scar locations. This is always a potential aesthetic concern in young people, particularly in thicker Asian skin. My point being is that you have to have a really good reason to do these lifting procedures as you don’t want to trade off one aesthetic problem for another.

Dr. Barry Eppley
Indianapolis, Indiana