Q: Dr. Eppley, I would be pleased if you could tell me if in my case whether an endoscopic midface lift would help to get rid of the sagging face after cheekbone reduction?
A: I have read through many explanations of facial sagging and its causes and treatments after cheekbone reduction surgery and find very little of substance there that is helpful. It only tells what is already known…that if the osteotomized bone segments are not stabilized by plate and screw fixation (particularly at the zygomatic body) the natural contraction force of the masseter muscle will pull the entire cheek segment downward including the attached soft tissues. In addition, over release of the masseter tendon from the zygomatic body will have the same effect even if the bone is properly stabilized in an inward and superior position. Fixing this type of msuculofascial sag is not going to be helped by any overlying skin repositioning maneuvers such as any type of facelift procedure that merely pulls on the skin. Thus, while any sort of midface lift may be of some help, it does not fully address the root cause of the facial sagging…musculofascial contraction.
For all intents and purposes, it is not really possible to reattach or lift scarred masseter muscle. This is why some form of skeletal cheek augmentation is usually needed with the lift to volumize the submalar cheek zone. This could be done with either implant or fat augmentation.
Dr. Barry Eppley