Temporal-Based Cheeklift for Soft Tissue Sagging after Cheekbone Reduction
Q: Dr. Eppley, I had an L-osteotomy zygoma reduction at 20 years of age, and then I had a temporal incision midface lift one year later to hopefully correct the cheek sagging I experienced.
Unfortunately, the midface lift yielded no appreciable results. I look exactly the same as I did pre-surgery and I am devastated.
What can I do to correct my cheek sagging for the long term? Would it be possible to re-do another midface lift when I am much older or are my cheek tissues too scarred and atrophied to do so?
A: The reason your endoscopic temporal-based cheeklift did not produce any appreciable change is not a particular surprise for the following reasons:
1) The concept of lifting facial tissues by any method is predicated on that there is a natural age-related tissue ptosis in an unscarred tissue base. Such is the case in the older patient who has developed cheek sagging from aging. This is the basis on which all cheeklifting/midface lifts were developed. It was never designed for the very young patient with good tissue elasticity and recoil who developed some moderate cheek sagging from a loss of bone support due to a surgical procedure. In short while the concept of a surgical cheeklift to correct cheek sagging from cheekbone reduction makes senses, it is being applied in a situation where it is very difficult to make it work.
2) While not having any significant scarring from a temporal-based cheeklift is appealing, the reality is that the vector of pull is really in the wrong direction. The cheek soft tissues have fallen vertically from their disinsertion from the bone but the temporal-based cheeklift is trying to pull them in an oblique direction with suture traction on the deeper cheek tissues applied from the intraoral approach. Optimal correction is in the vertical direction with a more cranially-based or vertical vector cheeklift with suture traction applied to the more superficial SOOF layer of the upper cheek tissues. But to do so requires an eyelid incision which in a young person is more difficult to accept one must always be wary of any other aesthetic trade-offs.
3) It is also possible that your cheeklift results are because of how it was performed. Some operations don’t work well because they were performed poorly. But I will assume it was done in the best manner possible.
In short, while the type of cheeklift you had has its limitations, it is done as the most acceptable approach in a very young patient. It was certainly worthy trying but it has a relatively high risk of not creating the correction the patient wants as you have experienced.
Dr. Barry Eppley