Cheekbone Reduction Sagging

Q: Dr. Eppley, Late last year I underwent cheekbone surgery on the left side of my face to correct some asymmetry. I wasn’t aware that this type of surgery was offered in America, so I had this surgery in Thailand. From my understanding of the surgery, I had an L shaped wedge of 5mm taking out of his front body cheekbone and the back thin cheekbone was moved inwards through a cut in the sideburn area. Everything was fixed with metal screws. Ideally I would have undergone the back cheekbone cut-only surgery to correct my asymmetry, but the doctors who consulted with me in Korea were too pushy on having additional surgeries and did not make me feel comfortable to have surgery there. The hospital in Thailand where I did the surgery did not offer this other type of cheekbone reduction either.

It’s been four months since the surgery now and much of his swelling seems to have gone down. Around the left jaw area, I don’t seem to have any jowling or excess skin happening which is a good sign.

However, the apples of my cheek now seem slightly lopsided, and it’s most evident when I am smiling. My cheek flesh seems tacked on but it has tacked on slightly more down than it was before, if that makes any sense.

It was an understandable risk. I have read through your blog after finding it online, and it makes logical sense that when flesh is taken off bone, it doesn’t stick back down to the bone (as much as we would love for that to happen.) It’s not an evident or drastic sag, but unfortunately it is quite noticeable.

Do you have any suggestions on what surgeries or alternatives I can pursue at this point to just slightly lift this cheek tissue a bit higher up? At a year post-surgery I plan on getting the metal screws out. When the cheek tissue is relifted to remove the metal screws out, is there some method to get the flesh to stick back down higher at the same time.

Or do you suggest that I just leaves the screws in? Would relifting the flesh to remove screws just result in making the drooping worse?

A: In answer to your cheekbone reduction sagging questions:

1) It is not an absolute necessity that the metal plate and screws are removed. While it is not likely to cause further soft tissue sag, there is always that risk.

2) The only reason to remove the metal hardware is if the primary reason for the surgery was to try and address the soft tissue sag through a lift or resuspension procedure or even the placement of a small implant. The hardware removal then becomes a coincidental part of the procedure.

3) Other non-intraoral approaches to managing the cheek sagging may be a cheek lift procedure done through a lower eyelid incision or even fat injections to add back some volume.

4) Each management strategy to sagging after cheekbone reduction (intraoral resuspension, implant augmentation, transcutaneous lowe reyelid cheeklift and fat injections) has their own advantages and disadvantages.

Dr. Barry Eppley

Indianapolis, Indiana