Treatment Options for Cheek Sagging after Cheekbone Reduction Surgery

Q: Dr. Eppley, I’ve been consulting surgeons in my home country to fix cheek sagging that happened after a cheekbone reduction. I hope you can give me advice because I am really stuck and very confused about what exactly I need.I am in my mid 20s and I have received varying responses from different surgeons about what they think I need. I’m not even sure what it is I need anymore.

My major problem areas are deeper nasolabial folds and puffiness around the sides of my mouth. It wasn’t a problem I had before and I would like the most ‘permanent’ solution that I can get.I’ve been suggested temporary fillers, thread lifts, fat grafting, cheeklifts, and more. I’m tossing up between the thread lift and cheeklift.  I was offered a TESS lift which is kind of like a threadlift but using permanent sutures. But I’m worried it will not have as good of an effect as it only tackles the uppermost tissues when I think the deeper tissues need to be moved.

I read on your blog that cheek sagging could be helped with an endoscopic scalp/intraoral technique or using a bone suture intraorally. Are these two techniques applicable in my case and do they tackle the deeper tissues as I need? Thank you.

A: Midfacial tissue sagging is a not uncommon aesthetic problem after cheekbone reduction surgery which is a difficult problem to improve. That is why there are so many different treatment options for it, a sure sign that there is no one universally effective treatment technique. 

The fundamental differences in the treatment approaches for postoperative cheek sagging is whether it provides more of a superficial or deeper aesthetic effect. Synthetic and autologous fillers material exert more of a superficial outward pushing effect which adds volume and fills out the tissues but with only a very limited cheek lifting effect. Implants at the bone level add volume and a more effective checklist but seem counterintuitive give the reason you had the surgery in the first place. Cheeklifts, of which there are a variety of techniques, provide a more effective soft tissue lift as the deeper tissues need to be mobilized. I would avoid placing any type of permanent sutures or threads as at your young age the placement of such materials in the facial soft tissues dos not seem like a good long-term strategy.

Dr. Barry Eppley

Indianapolis, Indiana