As we age and facial tissue starts drooping, our face becomes more square-looking. A mid-facelift re-shapes the face by lifting the cheek fat pad back up to the cheekbones, where it was during youth. This process also smoothes out the naso-labial folds (lines between the nose and mouth) that form over time because the cheeks sag. It also lifts up the corners of the mouth, giving a more cheerful look.
Some people are afraid that a facelift or cheeklift will give them an overly surprised look. But with a cheeklift, the eyebrows need not be raised; they can be lowered if that’s more appropriate, or just left alone.
The cheeklift can also include work on the corrugator muscles which create those vertical frown lines between the eyes.
It can be done on an adult of any age, even over 70.
Facial aging is thought to occur in 3 zones:
- The upper third (forehead and upper eyelids;
- The middle third (nose, cheeks and lower eyelids); and
- The lower third (lips, jawline and neck)
From when they started in the early 1900s, traditional facelifts have generally focused on the upper and lower thirds of the face, correcting jowls, wrinkly necks, frowns, sagging eyelids etc., but not so much on the middle third.
Since the 1970s, they have made huge progress in procedural techniques, ease of recovery and efficacy of outcome. And in the early 90s, cheek implants were developed, which helped to include the mid-face more effectively. But there has always been some difficulty in working from the upper face to the mid-face because of the risk to the nerves that run between the two areas.
It was not until the endoscope was introduced in the 1990s for facial surgery that large progress was made on mid-face procedures.
An endoscope is a small fiberoptic tube that can be inserted through an incision. It can be loaded with a tiny lens and camera and/or with tiny surgical instruments such as scissors, forceps and retractors. As he works, the surgeon sees his movements and their results on a television screen.
One of the big advantages of endoscopic surgery is that incisions can be very much smaller - between a half-inch and one inch.
How is it done?
It takes between 3 and 4 hours and can be done with general anesthesia, or with local tumescent anesthesia and IV or oral sedation. (Tumescent anesthesia means that it’s injected in a large volume of saline solution, along with epinephrine to minimize bleeding. This helps to separate tissues and makes more room for the surgeon to work in.)
From an incision inside the mouth, the relevant structures are identified. Then an incision is made in each temple, inside the hairline, from which stitches are placed connecting the cheek pads to the temporal area. If desired, a cheek implant can be positioned at the same time, to give the cheekbones more prominence in the overall facial shape.
The stitches are permanent and placed deep down at bone-level, where they cannot be felt. Eventually the tissue adheres to the bone and stays there. No muscles need to be tightened, which minimizes bruising afterwards. Nor is any skin removed. The residual scars are small and not visible, since the incisions were inside the mouth and under the hair.
There’ll be some swelling and bruising, but less than in a full facelift. You can be back at work anywhere between a week and a month post-op, depending on how strenuous your work is. In the first couple of days you can use ice to bring down the swelling. You might feel some numbness or weakness in the middle part of your face but it will not last long.
The main possibility is that the stitches holding the cheek tissue in its new position might break. This can be minimized by using tape to hold those stitches in place for the first week or so. The cosmetic surgeon will decide whether to do this.
In very rare instances, there can be partial damage to a facial nerve, but it is very rare indeed, as long as you’ve chosen a properly qualified and experienced facial plastic surgeon.
Cheeklifts are a state-of-the-art procedure, less traumatic than a full facelift, require a shorter recovery time, and yield very rewarding and long-lasting results.
If your or someone you know is considering facelift surgery, please contact an experienced cosmetic surgeon such as Dr. Goldstein in Providence, RI and Madison, CT.