Speaker 1: Welcome to plastic surgery talk with Dr. Stephen Mulholland, brought to you by SpaMedica.
Dr. Mulholland: Hello and welcome. Dr. Stephen Mulholland, welcome back to plastic surgery talk here in Toronto, Canada. We’re here for our weekly podcast series. This week’s podcast is on the cheek lift.
If you find these podcasts engaging, entertaining, informative, please subscribe, share, and comment.
What is a cheek lift? A cheek lift is the specific and selective elevation of the cheeks. The cheeks are subtended and contain the soft tissue elements called the malar fat pad that exists between the lower lid and the corner of the mouth.
A facelift would include a cheek lift, jawline neck lift, and those elements would be a facelift. A cheek lift is a subcomponent selective elevation, a portion of a facelift, basically, particularly called the midface, a very popular and important treatment, because the cheek is often the very first part of the face that tends to deflate and sag.
It elevates the lower lid cheek junction. The cheek fat pad subtends and falls into the lower parts of the face. We get overhang of the nasolabial fold, descent of the mid cheek down onto the jowl, and then heaviness of the jowl.
Often, it’s the midface that gets elevated first. It may be done in combination with other procedures, but the cheek lift itself is a very selective stealth elevation of the midface, designed to create a more oval shape to the face that’s become a bit boxy.
How is the cheek lift performed? The elevation and creation of the modern cheek lift has undergone some really high tech renovations and evolution. Typically, it’s limited access. What does that mean? Well, I can elevate the malar pad, the cheek fat pad, those little rosy cheek fat pads that sit high up on your cheekbone.
We can elevate when they’ve fallen down by going through the mouth with a little pinpoint incision, elevating the cheek fat pad right off the cheekbone under local anesthesia. We can then close that little pinpoint incision in the mouth with an absorbable suture, and then come from the temporal or the side temple hair region, the hair bearing area, with fixation systems.
There’s different ways to lift the cheek and hold it there. Typically, they all tend to be bioabsorbable, either the Endotine or Ultratine, or passing modern bioabsorbable barbed sutures. These constructs can elevate the cheek, and while it’s healing, hold it in position.
Once the cheek is healed to itself and to the underlying cheekbone, the dissolvable bioabsorbable threads go away, and the cheek holds itself to itself through autogenous fixation.
Modern cheek lift surgery can be done in about an hour, under local anesthesia. Elevation of the cheek fat pad, which softens the jowl, and takes a boxy look and makes it more oval. The fixation system is hidden in the hair so there’s nothing visible.
Typically, these retention devices like a barbed suture go away over about three to four months, leaving the elevated cheek and the more oval looking jowl face junction looking youthful.
Who’s a good candidate for a cheek lift? Well, those patients and individuals, male or female, that have noticed a deflation of the cheek and descent of the cheek. As we get older, there’s three de-aging … deflation, air out of the balloon, then the balloon descends, it falls, and that includes the cheeks.
As the cheeks deflate and descend, we get an elongation of the lid cheek junction, so the lower lid looks evacuated. The cheek itself, or the malar pad looks flat, and old, and hollow. The soft tissue that was formerly high in the cheek descends down onto the corner of the mouth and the jowl, and we get dowdy and jowly.
A candidate is that patient, male or female, that have shown those aging signs of deflation, descent, and deterioration of the cheek and the midface structures. They have a good understanding of what’s involved, the risks and the benefits. They have expectations that are reasonable. They have good hair bearing hair that we can hide the fixation elevation port in, and they’re willing to take at least a week off work to recover from the swelling and the bruising that can occur.
What are the contraindications to a cheek lift? Typically unrealistic expectations, medical conditions that are uncontrolled. Patients should not be pregnant. They should not have implantable devices in their cheeks. It makes it much more difficult if there’s been a previous cheek augmentation with silastic or silicone. There should be no liquid injectable silicone, no injectable element in the way of the elevation.
There should be no periocular pathology that’s been undiagnosed like glaucoma or retinal diseases. Patients should have set aside the appropriate amount of time to recover and not feel rushed back to work. There should be no perioral or dental pathology that’s been untreated, such as an apical abscess or tooth root infection.
If all those things have been met, all this criteria, and the patient has realistic expectations, a cheek lift can be one of the most pleasing facelift operations we have.
What are the steps in a cheek lift? Basically, a patient is prepped and draped. The areas of the cheek that have fallen are marked out. The incisional approach, usually transoral or in the mouth, is injected with local anesthesia. The hairline approach is injected with local anesthesia.
We elevate the cheek from inside the mouth, close that little port with a bioabsorbable suture, and then retain the now freed up cheek from above with a temporal support structure, or a temporal hairline support structure such as a barbed absorbable suture.
The postoperative course is generally a bit of swelling and bruising, but not much. The pain is modest, usually like a brow lift, two or three out of 10 versus a tummy tuck or a breast augment. That’s an eight or nine out of 10. Usually most patients can get by with a nonsteroidal antiinflammatory.
Typically, a patient will take about one week off work, during which time the swelling comes down. The pain generally subsides to a mild bruise discomfort. It’s very, very important postoperatively that patients avoid sleeping on their face and putting pressure on their cheek lift, on their midface lift.
Sleeping with a airplane pillow, a type of apparatus around their neck so you can’t turn onto your face or onto your side for about six weeks, until the elevation and fixation of your midface has stabilized, and you can go back to normal high impact activities and sleeping on your side.
What kind of results can you expect from a cheek lift or a midface lift? Typically, a very pleasing and significant elevation of the cheek and the malar fat pad with a lessening of the jowl.
We can take you from looking very boxy, jowl dominant, and reposition the midface and open up the bizygomatic width, the distance between the two arches and make that fuller again with your own tissue, your own fat. We can create a much fuller, more youthful midface.
The lid cheek junction shortens so you look less tired. The midface is elevated, which pulls the jowl out of its dowdy jowly look. You get a more oval, more youthful look. You could do that without the big incisions and scars associate of typical facelift surgery, because it’s done through two small stealth ports in the mouth and through the temporal hairline.
What are the risks and complications potentially with a midface lift? Well, there are substantial risks and complications potentially with this procedure, but done well in well-trained hands, they’re very, very rare.
Undermining under the cheek can sometimes stretch the facial nerve, and there’s a little bit of weakness in the perioral movements of the fine muscles of the lip. There can be some weakness, some difficulty with oral competency if you’re drinking fluids, but that typically lasts two to three weeks and generally will go away.
There could be some numbness from elevating the soft tissue that typically resolves soft tissue infection or abscess. We use preventative antibiotics. The scars are typically not an issue because they’re just not in visible open skin. They’re in the hair and in the mouth.
On the balance of weighing the risks and the benefits, this is a high satisfaction procedure, where the benefits quite markedly outweigh the risks. The recovery is generally within a week, and patients find it to be one of the most pleasing isolated facial elevation elements in our facelift tool of opportunities.
How much does a standard midface or cheek lift costs in North America? It depends on the city, on the surgeon, but in general, you can find ranges in midface cheek elevation prices from $6,000 to $10,000 in the low to mid range, and $15,000 to $20,000 in bigger cities, bigger markets, and surgeons with a tremendous reputation for creating beautiful midface lifts.
One of the benefits of the midface, it does last for a good eight to 10 years. It does take that boxy, older dowdy look and create a more youthful oval. It brings back a more rested look to the lower lid. It just has so many nice benefits that it’s become one of the most popular selective, isolated facelift techniques that we have.
Are there any combination treatments that you can do in addition to supplementing or augmenting, amplifying the cheek lift and the midface lift? Well, the cheek lift midface lift goes very nicely with a lateral tailored brow lift. A brow lift and midface lift gives an upper two third elevation to the aging face.
It can be combined obviously then with the jawline and neck lift, and then that becomes a facelift. One can combine a cheek lift with lip augmentation or a rhinoplasty. Bigger nose, smaller, smaller cheeks elevated. You can combine the cheek lift with a nose job and eyelid surgery to look more rested, a little more feminine, a more refined nasal appearance.
You can combine the cheek lift with fractional laser resurfacing to get a more oval look to your face and smoother skin, particularly if you have wrinkles, acne scars, or macro pores in the T-zone. The midface lift or cheek lift lends itself to combination therapy with many other isolated techniques that can aggregate and amplify the result.
Thank you for joining me. Again, Dr. Stephen Mulholland, here in Toronto, Canada, on Plastic Surgery Talk, another installment on our podcast series. This one was on cheek lift and midface lift.
If you found these podcasts engaging, entertaining, informative, please subscribe, share, and comment. See you next time.