How Can I Correct Facial Sagging After Cheek Bone Reduction?
Q: Dr. Eppley, I was searching for the information regarding facial sagging after cheek bone reduction surgery. I suffer from facial sagging after cheek reduction surgery that I had four months ago. Even though my bone is tightly fixed, sagging is quite severe and it keeps getting worse. I think it might be because of the loss of skeletal support. He didn’t reposition the unit of my cheek bone but removed part of my front cheekbone by dissecting it as an ‘L-shape’. The worst part is that only the right side of my face is sagging and I don’t know what to do. I’ve been searching for some doctors who are renowned for face lifting. They said that they need to release the zygomatic ligaments and lift the SMAS up as well as the skin. I can see that you are the one who understand the right reason and solution of this problem. So I will be truly thankful if you spare some time to give me some advice. Thank you so much.
A: I am sorry to hear of your unfortunate unilateral outcome from your cheek bone reduction surgery. The obvious origin of the problem is the loss of ligamentous attachments of the overlying soft tissues to the cheek bone as well as the loss of skeletal support for them. It is interesting, assuming that the same bone reduction techniques were done on both sides, that only one side of your face has this tissue sagging problem. This shows how precarious the soft tissue attachments are to the bone and how slight differences in dissection techniques can make a big difference in their outcomes. As has been pointed out to you, the key to improvement is not just the skin shifting but the need for deeper soft tissue repositioning. The only tissues that possible to relocate are the SMAS layer. But moving the SMAS layer without giving it skeletal support will not provide a significant improvement. The first place to start is to have a good idea of what the underlying bone support looks like between the two sides. I would recommend that you get a 3D CT scan to visualize your cheek bone anatomy as it is now. Then with that information a more complete surgical plan can be devised as to how to manage the bone and the soft tissues.
Dr. Barry Eppley