The cheeks form the outline of the midface and frame the eyes. The composition of the cheek is the cheek bone, muscle, fat, and skin. During youth the soft tissue contains sufficient integrity and volume to project well-defined cheeks even when the cheek bones are not prominent. As we age, the volume of fat decreases and muscle atrophy begins. Then the anterior cheek area begins to flatten and wrinkles appear. Most remarkable to the patient is that the bags under the eyes begin to appear as though they are bulging out, and the lines around the mouth (nasolabial folds) appear deeper. The face begins to show signs of aging. Younger individuals may also show premature signs of aging when the bone structures are either in disharmony or simply locally deficient.

What happens during the consultation?

During your initial consultation your cosmetic surgeon will assess the true cause of any deficiency and present you with treatment options that address your concerns. On occasion, a treatment is suggested to mask an underlying problem without directly addressing the cause. This is done when the surgical options are too comprehensive, unsafe, or simply inconvenient.

A traditional approach

The traditional surgeon will likely address the symptoms. The symptoms are those of what is called herniated infraorbital fat pads and prominent nasolabial folds. It is very tempting to directly address only the symptoms by performing blepharoplasty to reduce the bags under the eyes and injecting Restylane® in the nasolabial folds. Those procedures alone may not rejuvenate the aged midfacial complex.

Modern thinking

To rejuvenate the cheek and the midfacial complex, volume restoring procedures-such as a cheek implant-must be considered. The surgeon will determine the amount of bone deficiency and will restore that with a Malar Augmentation or even Pyriform Augmentation. Malar augmentation (Cheek augmentation) will restore volume just below the infraorbital fat pad, thereby rejuvenating the entire midfacial complex without excising any tissue. The pyriform implants have the ability to restore the sunken look on either side of the nostrils. By restoring volume in front of and behind the nasolabial folds, the folds will not appear to age the face. As result of restoring the volume with an implant, wrinkles will diminish.

Implants are one form of volume restoration. Autologous Fat Transfer is another. Fat transfer is “autologous” because the fat is harvested from the same individual in whom it is used. The fat is prepared and injected in the appropriate areas. Autologous fat transfer is favored by some because it can be injected in a broader area where it is needed as opposed being limited to the shape and size of the implant. It is considered more natural and non-allergenic because it does not introduce any foreign substances.

Modern midface rejuvenating procedures have emerged that directly address the soft tissue mound of the cheek. These procedures have evolved with the ability of the surgeon to perform endoscopic procedures with minimal incisions. The Midface Lift also known as cheek lift. is a procedure that will raise the sagging soft tissue of the cheek. An endoscopic midface lift will imbricate the cheek in such a way that will elevate and increase the forward projection of the cheek just below the infraorbital fat pad.

The midface lift can be performed by itself or in combination with other procedures. When the skin is showing signs of sagging, the midface lift can be combined with a Face Lift or one of the less invasive procedures such as the contour thread lift. A midface lift is often performed in conjunction with a face lift due to the enhanced esthetic results that can be achieved when the curvature of the face is restored.

The Contour Thread Lift is one of the new and cutting-edge noninvasive surgical techniques intended to lift sagging skin with minimal intervention. Because the cheek is a curved mound of tissue, the surface tension on the skin elevation achieved with contour threads alone will flatten the cheek. Therefore, combining contour thread lift of the cheek and the midface structures with a midface lift is often more effective. The midface lift is a technique that imbricates the cheek fat and muscle thereby restoring and rejuvenating the cheek mound.

Therefore, in rare instances Orthognathic Surgery is recommended to bring about a change of the bone structures of the face. Orthognathic surgery is a complex surgical approach reserved only for patients with no other option.