Q: Dr. Eppley, my malar fat pads has dropped away from my cheekbone on my right side significantly and to a lessor degree on the left side. I had a vial of Voluma injected which was just partially successful.  I would like to know what procedure you prefer to elevate my pads?  My goal is to not only lift the malar fat pad but at the same time make sure that the skin/tissue at the nasolabial fold is elevated.  The most popular way seems to be sutures attached to malar fat pad and then pulled toward the temple where it is anchored.  I am open to hearing what method you prefer to get the best results.  I know you and I previously discussed the possibility of a more vertical lift to that area with an incision in the scalp and using sutures to elevate the midface area.

A: There are a variety of methods espoused for lifting the cheek soft tissues (cheeklifts) of which the temporal suspension approach is the most popular. In lifting the cheek tissues it is all about what direction (vector) to lift and where to suspend it. In reality the most effective approach is a purely vertical one done through the lower eyelid and attached directly upward vertically to the skull behind the hairline…this is also the most powerful cheeklift and one of my favorites as the downward drift of the cheek is vertically off the bone. It is very technically sensitive and requires some craniofacial experience which is why it is the rarest form done even if it is the most effective. The more limited version of this approach is to suspend the cheek tissues to the orbital rim through the lower eyelid incision. While popular the temporal suspension technique is not really the ideal direction (oblique vector) but is technically easier to perform. Regardless of the cheeklift technique used, its effects on the nasolabial folds are not profound and often short-lived.

Dr. Barry Eppley
Indianapolis, Indiana