Midface Lift for Cheek Sagging after Cheekbone Reduction
Q: Dr. Eppley, As a surgeon with experience in Asian cheekbone reduction/narrowing surgery, I hope you can advise me on the best path.
It’s been around 6 months since my surgery. I have thick, acne-prone skin and I believe this combined with the surgical dissection has resulted in some slight cheek sagging. From a bony point of view, I am pleased with the results but I am now consulting to fix the soft tissue aesthetics – by that, the mild sagging.
I consulted with a highly experienced craniofacial plastic surgeon in my city. He advised me that this type of sagging is nothing he hasn’t seen before with his experience in cheekbone repair and cheek implant removals. His take on my situation was that fillers would be extremely temporary at best and that fat grafting or cheekbone implants would be unideal in my situation with my reason for having the surgery in the first place and my thick, chubby tissues.
The surgeon told me that since gravity was the problem, pulling the tissues back upwards was the solution – He pointed me in the direction of a midface lift (not endoscopic, using sutures) via incisions in the temple and reusing my cheekbone intraoral incisions.
The procedure does sound like it will address the real issues, but I am very worried as I am only 25 years old. I am very much aware that facelifting in a young individual can lead to disastrous results and I am worried this may lead to a look that is “done” or “windswept.”
I am especially worried about the risks of nerve damage with a subperiosteal midface lift from the temple and mouth. I have read online about another individual’s experience of synkinesis after a midface lift.
I want to put my faith in my surgeon but of course, I understand that there is no 100% of no complications. As a highly regarded and experience craniofacial plastic surgeon, what do you think of this surgical plan? Is it prone to a lot of nerve and aesthetic complications in a 25 year old?
A: Thank you for detailing your cheekbone reduction surgery history and the not uncommon postoperative sequelae of some soft tissue sagging. In short I think the surgeon you have seen as summed it up nicely and the logic of coming to some form of midface lift is both logical and practical in your situation. While the potential complications to which you have described can occur, they are not ones I have seen, albeit one time on one side, and would not be the issue that would be of primary importance in making the determination for further surgery. I would be thinking about what are the chances of success in lifting the cheek tissues in a young person who does not have a tissue sag due to aging with naturally tighter tissues and the risk of undergoing an operation that may not work as well as you would like. It is important to remember that all facial lifting operations have their origins in aging patients with loose tissues that have lost elasticity. Trying to accomplish a real cheeklift in a limited exposure procedure in a young person does not work the same as in the older patient.
in short, I consider it a low risk procedure for medical complications but a higher risk one for truly correcting your cheek sagging problem.
Dr. Barry Eppley