Lower Midface Fullness Reduction (Facial Derounding)
Q: Dr. Eppley, I really dislike the lower-mid portion of my face, which seems to be getting worse (sagging) as I age…the area closest to the nose around the nasolabial fold.
I’ve asked many doctors about this bulge and they all suggest cheek implants or filler. I’ve had filler in the cheekbone area and while that helps to hide it, I still want to address the bulge because with the filler in the cheekbone I just end up looking too bloated for my liking.
No one seems to have an answer for how to address the fullness in those areas. I’ve gotten a couple of mid face lift suggestions but from what I understand, the lift will move some tissue up over the malar area but not really attack the bulge because the incision too far away to reach that area of correction. An I correct here? Could a modified lift be done with your ingenuity with an incision closer to the area?
I consider myself a highly motivated patient and would be willing to undergo a two or three or multiple stage surgery where after the fat or muscle or whatever it is removed, then the area and skin is tightened and then scar revision done if the scar is more visible to my liking in a young patient like myself. I wear make up and am fine with revising scars with lasers, injections and even scar revising surgeries if I can get a good aesthetic pay off.
Also do you think it’s more muscle, skin, or fat that is there?
Attached are photos of the issue I’m speaking of and following photos circled are areas where it is flat and in my opinion, ideal
A: Thank you for sending your pictures and detailing your concerns. Unfortunately the facial area (lower midface fullness reduction) to which you refer is a very difficult if not impossible area to significantly improve. While some slight reduction of it is possible, if your goal is the male picture in which you have circled, such a result is not remotely possible with any surgical method. While small cannula liposuction can be done in the nasolabial fold/perioral mound area I would expect the result to be very modest. This is a facial area in which the buccal branches of the facial nerve exist eliminating the possibility of any excisional approach regardless of a lack of concern about scars..
Dr. Barry Eppley