Many of my patients come in with concerns of sagging and descent of the cheek or midface.  They may not realize that their concerns are due to mid face descent but most patients in their mid to late thirties complain about similar things.  They know that they are not a candidate for a full traditional facelift though they have concerns and want to look better than they do and possibly put off a larger surgery for several years.  They are starting to notice hollowness, deepness and darkness under the eyes, more pronounced lines beside the mouth, and loss of volume in the cheeks and face.  While some patients may start to see some extra skin in the neck and lower face for a majority of patients the area of concerns is around the midface or cheek area.

As we age the cheek tissue begins to descend from the cheek bone and move slowly down the face.  This shift in fat and tissue, although small, creates noticeable changes in the areas surrounding the cheeks.  The area just below the eyes that used to transition smoothly to the fullest part of the cheek in your youth is now divided by a deep and dark rut.  The cheek tissue removes volume from the under eye area as it descends which presents itself as a tired and dark appearance that is almost impossible to cover with a concealer.  The nasolabial folds, running from the corner of the bottom of the nose to the mouth, are affected as well because the tissue that is slowly shifting downward on the face is putting increased pressure on the folds causing them to be more pronounced.  With the cheeks shifting downward it can cause a face that was once full and youthful to appear gaunt or sunken.  The cheeks themselves are a symbol of youth.  When you see a child, or a young super model you see fuller, round and shapely cheeks which balance the face and accentuates other key features including the eyes and lips.  Although the aging process is a very slow one some patients seem to feel that these noticeable changes happen over night.  The subtle changes brought about by the shifting of the cheek alone effect the symmetry of the face in such a noticeable way because it manages to alter every key part of a patient’s face.

In some cases dermal fillers may be used to increase volume in targeted areas of the face.  Fillers can be especially effective in the tear troughs to help combat the hollowness caused by aging.  Stimulatory fillers such as Sculptra® may be used to combat facial volume loss with a series of treatments over time for patients that may prefer a more subtle treatment with longer lasting results. Other fillers can be used to bring fullness to the cheeks or to help fill the nasolabial folds.  If volume loss is the primary concern the use of fillers alone may provide a pleasing overall result.  Keep in mid that the use of fillers is merely a form of camoflague and provides a temporary fix until a patient is ready for surgery which will repair the problem area and is long lasting.

For patients where facial volume has shifted in a displeasing way or for those who want a more permanent fix, an endoscopic cheeklift is the best option.  During the first part of an endoscopic cheeklift, I reposition the fat and tissue of the cheek back onto the cheek bone where it once was.  I use a product called Endotine™, which is made of a material similar to dissolvable sutures, to hold the cheek in the proper position while it heals. The Endotine™ will dissolve over several months leaving the cheek secured in it’s new position. By restoring the cheek to its original location the patient enjoys increased volume under the eyes, less pressure on the nasolabial folds and a youthful appearance to their cheeks from which they have benefited from during their younger years.  The second part of the procedure involves the under eye area.  Depending on the patient I may use one of two techniques to renew and tighten the skin under the eye.  For some patients laser skin resurfacing is utilized to renew the skin while for others a lower Blepharoplasty may be performed to remove  fat from the lower eye area leaving the skin smooth and firm. Addressing the lower eyelid is necessary as it ensures that the patient has a flawless transition from the lower eye to the cheek and the skin is reconditioned to perform how it once did naturally.  It’s not about adding volume (in most cases); it’s about repositioning the existing volume in a more pleasing way.

Actual patient before (left) and after surgery (right)

It is important to know that this is NOT a “mini” lift that can be done under local anesthesia during a lunch hour. These “quick-fix” surgeries are designed to require a shorter recovery time and smaller investment but with that will yield a lesser and more temporary result. The endoscopic cheeklift surgery that I perform takes a little over an hour and is performed in the operating room which makes the procedure comfortable and keeps the patients still as I work.  The incisions are very small and completely concealed which means no visable scarring on the face.  Dissolvable sutures are used during this procedure and do not require removal. One week after surgery most patients return to their normal activities.  A small amount of swelling may remain even after the first week but will resolve over time leaving the patient with lasting and beautiful results.

If you are noticing that your eyes look more hollow, your cheeks are not as round and pleasing as they once were or that your nasolabial folds are becoming more pronounced and this is concerning to you; it may be a good time to schedule a consultation with me.  During your consultation we will discuss your concerns and figure out the best way to go about addressing them.  It is sometimes helpful to write down any questions that you may have prior to coming to your consultation to make sure that we cover all of your concerns.  If you decide that you would like to pursue treatment using dermal filler I will likely be able to administer the fillers the same day.  If surgery is a better choice, we will take some photographs which will be digitally enhanced so that you may better visualize your surgical results.  This is a great way to get a feel for what to expect if you choose to have surgery and to also be sure that you and I are on the same page in respect to your surgical goals.

The endoscopic cheeklift is one of the most popular surgeries that I perform in my practice.  Patients are starting earlier with surgery knowing that using fillers and having some smaller procedures now, can put off a dramatic overhaul in their fifties and sixties.  The endoscopic cheeklift is ideal for the patient that is noticing significant signs of aging in the midface but does not yet have major concerns in the lower face and neck area.  It utilizes advanced techniques that provide a very natural and youthful result with minimal downtime and lasting results.  I look forward to seeing you at your consultation and helping you look as amazing as you feel!