Cheekbone Reduction Surgery Tissue Sagging

Q: Dr. Eppley, Last year I went to a famous Chinese plastic surgery hospital for cheekbone reduction surgery. My cheeks were not extremely big but only had mild protrusion, but I still decided to go through with the surgery to get a thinner face. At 4 months after operation and after all the swelling went down, I was very pleased with the result. Now it has been almost 8 months since my cheekbone reduction surgery but I am starting to have a problem. I have attached a recent photo of me. The top photo is unphotoshopped and the bottom photo is what I would like to achieve.As you can see from the unphotoshopped photo, my face is saggy from excess skin and this extra skin is pulling my face down so I have deeper nasolabial folds. I would like to get more surgery done to get the bottom photo look (permanent solution), but I will not be returning to the Chinese plastic surgery hospital. My previous surgeon said the saggy skin is because I am naturally getting old (I am very young and my skincare routine is very good!!!)

1~ Please can you explain why my skin starting to sag at 8 months after the surgery? If I leave this skin alone will it get worse or shrink?
2~ What surgery should I do to achieve the bottom photo look. I would like a permanent solution as I cannot keep flying overseas for touch up. 
I would not like cheek implant because I underwent surgery to get rid of my cheeks in the first time. I would like to just cut the excess skin off but I do not know if there is a surgery for that.

A: Thank you for your cheekbone reduction surgery inquiry.

1) Your facial skin has sagged for one very specific reason…cheek bone support has been reduced and it has required the detachment of cheek soft tissues to do so. This is not a surprise and is one of the very well known aesthetic complications (technically it should be called a tradeoff) of doing this surgery. While it does not occur in every one who has the procedure, it is not rare. What you have now learned is that every cosmetic surgery has aesthetic tradeoffs, some procedures more than others.

2) There is no surgery to help you achieve your desired look now…not a cheek lift or even liposuction.

3) The soft tissue say you have now will be stable for awhile because of your young age. But when aging does eventually set in it will become worse as it does in everyone.

Dr. Barry Eppley
Indianapolis, Indiana