Facelift with cheek implants. Is it always necessary to combine the two procedures?
First and foremost, facial aging is not just about the loose skin and deep wrinkles, hence pulling and tightening the skin tissue does not always work as a stand-alone procedure if the goal is to achieve a more youthful and “refreshed” appearance.
Renowned Los Angeles plastic surgeons suggest that a multi-level approach works for many patients desiring to achieve a more youthful countenance. For this reason, facelift with cheek implants (or any other form of “volumizers”) has become a routine procedure.
A standard facelift rejuvenates the lower eyelid, mid face, jaw line, and upper neck by lifting the saggy skin and tightening the facial muscles. If needed, it will also reposition the saggy cheek fat pads, leading to a more angular or heart-shaped face, which is an improvement from its previous boxy appearance.
However, not everyone has sagging cheek fat pads. Naturally thin and “athletic” patients may lack facial fat, which can be compensated by cheek implants, dermal fillers, or structural fat grafting. It is important to note that the ideal volumizer will depend on two key variables: their goals and their underlying anatomies.
While dermal fillers injection could provide the same effects as cheek implants, their results only last four to six months, thereby they require regular touch-ups which in the long run will cost more.
Fat grafting is another alternative to cheek implants, although its results is highly variable because each surgeon has his own preferred technique. But basically this involves collecting donor fat from one area of the body, processing it to remove the biomaterials such as blood, and then re-injecting it into the recipient site.
Simply put, cheek implants are the ideal choice for someone seeking a more predictable and permanent solution for hollowed-looking mid face. Nowadays, most of them are made of solid silicone that can be easily extracted should the patients are not happy with the initial results.
Some patients may avoid or at least postpone facelift by filling in the cheeks with implants, fat graft, or dermal fillers, depending on their ultimate goals and expectations.
By filling in the hollowed cheeks, one of the leading Los Angeles plastic surgeons Dr. Tarick Smiley says it may soften the laugh lines, decrease the downturn of the mouth, minimize the hollowness of the lower eyelid, and provide some “lifting effect.” For this reason, some people choose to have cheek implant surgery and then wait for a few years before they resort to a more extensive procedure usually in the form of facelift, he further explains.
As long as the cheek implants have been properly secured onto the bone, a facelift in the future will not be able disrupt them, he adds.
The right technique used during an eyelid surgery under eye bags is determined by the underlying anatomies and the patient’s goals, according to California Surgical Institute website.
It is important to note that under eye bags are not created equal. Some are caused by the bulging lower eyelid fat, cheek descent, excess skin, soft tissue atrophy (shrinkage), or a combination of these factors.
Sometimes, the appearance of eye bags or “puffiness” is caused by smoking, stress, lack of sleep, fluid retention (due to allergies, medications, or hormones), or hereditary predisposition. Some of the aforementioned factors can be controlled through lifestyle changes or with drugs, making any type of surgery unwarranted.
A lower eyelid surgery under eye bags is ideal for patients with excess skin and fat. Typically, it uses a fine incision placed very close to the lower lash margin so the resulting scar is well concealed.
But if the only cause of the under eye bags is the excess fat, it is better to position the scar inside the eyelid, a technique medically referred to as transconjunctival blepharoplasty. Instead of removing the fatty tissue altogether, most surgeons these days prefer the conservative route—i.e., remove just a small amount or redistribute it to create a smooth transition between the lower lid and the upper cheek.
It is important to preserve some fats in the lower lids to avoid the skeletonized-looking or hollowed eye socket, which defeats the purpose of having a more rejuvenated appearance.
Oftentimes, the results of eyelid surgery are near permanent, although one downside is that it always entails a week or two of downtime. For this reason, some patients resort to non-surgical alternatives such as fat transfer or dermal fillers, which both act as a volumizer.
Dermal fillers made of hyaluronic acids are particularly popular as a non-surgical alternative to lower eyelid surgery. They work by adding volume to create a smooth transition between the upper cheek and the lower eyelid.
While fat transfer can also accomplish the same effect, its results tend to be highly variable since it boils down to how much grafts will survive. Any amount that remains after about three months of injection is expected to last a lifetime.
Instead of actually treating the lower eyelid, sometimes it is better to address the sagging cheeks through a cheek lift/mid facelift. To further achieve a more youthful appearance, it may be necessary to perform volume restoration at the same time.
A mid facelift with cheek implants is a common procedure to achieve more rejuvenating effects. However, honest discussion between the surgeon and his patient, proper patient selection, and physical exam will determine the viability of this approach, according to Brea Plastic Surgery Institute website.
During a mid facelift, the surgeon raises the drooping cheek fat pads that may contribute to the “heavy” jaw line and aged appearance. Another effect of this surgical maneuver is the elimination of the laugh lines, or medically referred to as nasolabial folds.
If needed, the surgery will also correct the sagging lower eyelid.
Cheek implants, meanwhile, are used to correct the hollowed or flat cheeks, which might be caused by aging or just an inherited feature. Most surgeons these days use silicone implants, which can be easily removed in case the patients are not happy with their results.
If the hollowed submalar cheeks are caused by the drooping fat pads, a mid facelift is enough to correct the aged appearance since it works by raising them up to a more youthful position. For this reason, the use of facelift with cheek implants are only reserved for thin-faced individuals.
As a stand-alone procedure, mid facelift is typically performed with the use of an incision behind the hairline that often extends around the ear’s contour. But when performed simultaneously with implants, it might be more ideal to place the scar close to the lower lash line.
Over time, the incisions near the lower lash line will fade into a fine scar that is imperceptible even at a conversational distance.
Contrary to popular belief, cheek implants are supposed to provide natural look and feel as long as they are positioned and secured properly. Some doctors suggest screw fixation to prevent “minute” movement, which over time could lead to resorption, asymmetric appearance, and infection.
Cheek implants come in different shapes and sizes, although they come in three basic types: malar implant for the lack of cheekbone prominence, submalar for the hollowness beneath the cheekbone, and malar-submalar for augmenting the two aforementioned regions.
Instead of cheek implants, some doctors prefer other forms of volumizers such as dermal fillers injections and fat transfer.
Dermal fillers such as Restylane and Juvederm are readily available materials whose effects can last 4-6 months, while fat transfer is believed to provide a more permanent result.
Despite the growing popularity of fat transfer, which is believed to provide more natural results and feel than synthetic volumizers, some doctors still prefer dermal fillers due to their more predictable outcome.
The results of fat transfer are quite variable since the graft’s survival rate is affected by the quality of donor fats and the processes involved to purify them.
Facelift for jowls typically involves an incision that goes around the ear’s contour that might be extended into the nape to provide more tightening effects. This is often achieved by the standard technique, which is primarily designed to rejuvenate the area starting from the lower eyelid to the neck area.
While most people would assume that jowl is caused by excess skin along the jaw line, it is important to note that aging happens differently from person to person. For instance, soft tissue atrophy or shrinkage can also lead to jowling and aged appearance.
Before and After Photos of a Patient Who Have Had Lower Facelift Surgery
Also, it is not uncommon for the cheek fat pad that has sagged to a significant degree to contribute to the appearance of jowl. In this situation, the standard facelift might be enough to address the sagging mid and lower face; this results in a hidden incision that starts from the temple, behind the hairline, and goes down and behind the ear and possibly into the nape.
However, a short-scar facelift in which the incision only goes around the ear may be enough if the sagging is isolated to the lower face.
Volumizers in the form of dermal fillers such as Restylane and Juvederm, pre-jowl implants, and fat transfer may also eliminate the jowling appearance. The idea is to plump up the skin and create a more youthful jaw line.
It is not uncommon to combine volumizers and facelift for jowls to achieve the most desired results, according to Brea Plastic Surgery Institute website.
Meanwhile, a good number of patients who complain about their jowl also have sagging neck, which can be improved with bilateral incisions behind the ears. But for additional contouring, a small cut beneath the chin may be necessary to further tighten the neck muscle.
Due to aging and/or massive weight loss, the platysma muscle in the neck becomes splayed. To address the unsightly “bands,” the muscles in the midline are sutured in a corset-like fashion; however, some patients will need a small amount of platysma removed as well to achieve the desired appearance.
Aside from eliminating the jowl and neck bands, a good surgeon should also create a smooth right angle under the chin.
While some patients can benefit from chin and neck liposuction to rejuvenate the lower third of the face, it must be done in a very conservative manner because removing too much fat can show the platysma muscle beneath the skin, leading to a more aged appearance.
Facelift for sagging cheeks aims to lift the fat pad that has drooped, which contributes to the hollowed mid face and jowling. Repositioning the malar fats also provides another effect—elimination of the nasolabial folds, or more commonly referred to as laugh lines.
There are several ways to access the sagging fat pads, although the most common is placing an incision near the temple, behind the hairline, that curves around the ear’s contours so the resulting scars are perfectly hidden within the natural creases of skin.
Before-and-After Photos of a Patient Who Received Facelift for Sagging Cheeks
Another option is to place an incision right beneath the eyelashes. Aside from lifting the saggy cheeks, the technique can also address the loose skin in the lower eyelids.
Compared to the standard technique, facelift for sagging cheeks cuts deeper into the facial muscle tissue so the “supporting structures” around the cheeks and nose are pulled up and attached into the structures of the lower eyelid. This technique avoids the windswept appearance, which is often caused by skin-only lifts and other older techniques.
Nowadays, most doctors use some kind of internal sutures to hold the facial muscle, tissue, and cheek fat pads in their higher, more youthful position. This technique is also believed to minimize tension on the skin, which in turn prevents poor scarring and wound dehiscence (breakdown).
But the aforementioned techniques will not work on thin patients—they either exercise/diet a lot or their gaunt face is an inherited feature—because there is no fat to be lifted or sculpted to begin with. This is where volumizers such as fat transfer/graft and dermal fillers like Restylane and Juvederm can be of great help.
Proponents of fat graft suggest that it provides more natural results than readily available fillers because it is about replacing “like with like.” However, its effects could be variable due to the resorption rate that can range between 50 and 10 percent, depending on the techniques used by surgeons.
Fat graft involves liposuction to collect donor fats, which are then purified, sorted, washed, and re-injected, making it a much more complicated procedure compared with dermal fillers, which are believed to provide more predictable results that can last an average of 4-6 months, according to Brea Plastic Surgery Institute.
In additional, dermal fillers, particularly those made of hyaluronic acid, have impressive safety track records. In fact, an injectable enzyme can easily reverse their effects, making them ideal for first-time patients who want to see the effects of volumizers before they resort to a more permanent solution.