• 
  American Society
  of Plastic Surgery
• 
  American Society of
  Aesthetic Plastic Surgery
• 
  American Association for Accreditation
  of Ambulatory Surgery Facility

SELECT A PROCEDURE: Face Lift | Mid-Face Lift (Cheek Lift) | Cheek Augmentation | Endoscopic Brow Lift (Forehead Lift) | Neck Lift | Blepharoplasty (Eyelid Lift) | Lip Augmentation | Otoplasty | Rhinoplasty

Procedure: Mid-Face Lift (Cheek Lift)

A mid-facelift or "cheek suspension" is a procedure designed to improve on the ptosis (sagging) of the structures of the midface. These structures are the lower eyelids, nasolabial folds (smile lines), nasojugal folds (the junction between the eyelids and cheeks), and the cheek fat pads. As aging occurs there is a progressive downward drift of these structures resulting in the prominence of the nasolabial folds and decrease in the prominence of the cheekbone. This results in an increase in jowls and nasolabial lines. This process results in what we all see as the first signs of aging, an accentuation of the "smile lines".

The midface lift corrects a majority of these areas by lifting these structures (skin, fat, and muscle) off the underlying bone and reattaching them higher. This decreases the nasolabial folds and increases the prominence of the cheekbones. The procedure is performed by making an incision along the eyelid margins and dissecting the tissues off the underlying bone. During the aging process, the tissues slowly drift downward off the bone. It is therefore necessary to resuspend these tissues to a higher position in an attempt to mimic the original youthful position. Permanent sutures anchored to bone in a more superior position allow for maintenance of the new position. Dissolvable sutures are used to close the eyelid incision. A minimal amount of skin is removed from the lower eyelid. In most cases, this operation is combined with other procedures to more completely rejuvenate the face.

Surgery

This procedure is often performed in conjunction with an upper and/or lower blepharoplasty (eyelid lift) to decrease the eyelid fat pads and skin. A browlift (lifting the eyebrows) may also be performed to elevate the eyebrows, which fall lower with age and gravity, and to eliminate wrinkles and creases from the forehead. Any combination of these procedures may be performed depending on your individual condition and your individual goals.

Anesthesia The procedure is performed under general anesthesia as an outpatient. In some cases you may stay at the surgical facility over night, or in a nearby hotel with a private nurse. The anesthesiologist and the surgical facility will bill separately for their services.

Duration of Surgery The operating time will vary depending on the patient and the extent of the procedure, and whether any additional procedures are performed. Generally, the time for a mid-facelift is approximately 2 hours.

Before Surgery Do not take aspirin or ibuprofen or products that contain aspirin for at least 3 weeks prior to surgery. Also refrain from consuming energy drinks or any herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center.

Photographs Photographs are taken at the time of your consultation. These are important aids in the preparation of surgery and become a permanent part of your record. Post-surgical photographs are also taken.

After Surgery No dressings are necessary for just a mid-facelift and only antibiotic ointment applied to the lower eyelid is used postoperatively. If other procedures are performed then there may be some dressings. Ice packs are applied to the sides of the face and over the eyes to help reduce discomfort and swelling. There is usually a moderate amount of swelling and bruising after a mid-facelift. You may experience swelling of the upper eyelids that may result in not being able to open your eyes completely. This swelling should dissipate in 2-3 days. You should try to sleep with your head and shoulders elevated, in an effort to help reduce the amount of swelling.

Taking the herbal medication (Arnica Montana), fresh pineapple and/or papaya will also assist in decreasing the swelling and bruising. You may bathe 24 hours after surgery, but do not get the dressings wet. Men should be able to shave after approximately 3 to 5 days.

Initial discomfort is controlled with oral medication but typically the pain is minimal. Most stitches are dissolvable but those that are not are usually removed in 5 to 7 days. You should apply antibiotic ointment (Neosporin or Polysporin) to the incisions twice daily.

Return to Normal Activity Most people return to their usual activities and to work approximately 1 to 2 weeks after surgery. It is acceptable to apply make up after 3 to 5 days. Strenuous sports and other activities should not be performed for 3 to 4 weeks. You may drive when your eyelids are no longer swollen and vision is not a concern, when driving does not cause pain, or when you are no longer taking pain medications. This usually takes 1 to 2 weeks.

Scars You should expect a scar on each lower eyelid. These are usually well concealed in a natural skin crease of the lower eyelid. In some cases, a lower eyelid incision is made on the inner aspect of the eyelid, in which case, there will be no visible external scar. All of the locations mentioned are tolerated quite well. All scars are however permanent. The width, height, and color of scars are unpredictable. Wear a sunscreen of at least SPF 30 or greater when outside to protect the scars from sunlight during the healing process.

Diminished Sensibility As with any surgical procedure, small sensory nerves to the skin surface may be cut when the incision is made or when skin is undermined. Portions of your eyelids and cheek will feel numb or have less than normal feeling. The sensibility in these areas gradually returns, usually within 2 to 3 months as the nerve endings spontaneously heal. There is a nerve along the bone just under the lower eyelid that provides feeling to your cheek, upper lip and one side of your nose that may be stretched or traumatized thus resulting in numbness of those areas. Typically the feeling returns but there may be some permanent diminished feeling. During the healing process the cheek area may become hypersensitive for a period of time. Some diminished sensibility may last indefinitely.

Swelling and Bruising Swelling and bruising of the eyelids or any site following surgery is normal. During the first 1 to 2 weeks your eyelids will feel and look swollen. The swelling will start to subside after the first postoperative week. It may take as long as 2 to 3 weeks for the last bit of swelling to recede.

Complications

HEMATOMA This is the most common complication and occurs when a collection of blood forms under the areas of undermined skin. It occurs in about 1 to 2% of patients and is more common in men. The body will absorb minimal bleeding. A larger collection may necessitate aspiration to drain the collection. Occasionally it will require additional surgery.

ECTROPION This is a retraction of the lower eyelid in a downward direction and may be due to a tight scar forming an attachment to the underlying bone. This may occur in less than 3 % of the time. It can also be from an excess amount of skin removed from the lower eyelid. It can be a very disconcerting problem and is best treated initially with massages along the lower eyelid in a horizontal motion as well as steroid injection. It would be unlikely for this to require surgery but in certain circumstances, further surgery may be necessary.

NERVE INJURY In addition to the small sensory nerves to the skin noted above, the other main nerve that is at risk is the facial nerve. Injury to this nerve occurs in less than 1% of cases. When it does occur, it results in weakness of the face when smiling. The other main nerve is the nerve that gives feeling to the cheek, upper lip and side of the nose. Injury to this nerve is very unusual. When it does occur, it results in partial loss of feeling to that side of the face. Some numbness after surgery is normal but if the nerve is injured, then there could be permanent loss of feeling. If the nerve or one of its branches is injured due to stretching it may take 2 to 6 months for recovery. If the nerve is cut there may be either partial or complete weakness of a certain area.

EDEMA (Swelling) This is a normal consequence of surgery and is best treated simply by elevating the head of the bed. The applications of ice packs or cold compresses over the eyes are usually helpful for the first 3 to 4 days. Swelling along the lower eyelids and upper cheek may take 4-6 weeks to totally resolve. Taking Arnica Montana and fresh pineapple are also helpful.

ASYMMETRY There is usually some asymmetry of the lower eyelids and cheeks and in some people this is marked and is the reason they seek surgery. All efforts are made to have the cheeks and eyelids as symmetrical as possible but it is important to understand that perfect symmetry may be difficult to attain. A slight asymmetry may be acceptable after surgery. A greater amount of asymmetry may require additional surgery to correct.

ABNORMAL SCARS A small percentage of patients will develop scars that are unacceptable despite meticulous attention to detail both during and after surgery. The scars may widen, stay red or raised. In some cases hair may not grow around them. If the scars are problematic, a steroid ointment or injection may be used to improve their appearance. In some cases the scars need to be revised surgically.

INFECTION This complication is also rare. Prevention is the key and antibiotics are given both before and for a period of time after surgery.

SKIN LOSS This is also a rare occurrence. It may be due to cigarette smoking in the days to weeks before and after surgery, or due to undo tension at the site of the incision, which could be compounded by swelling or hematoma. Usually this is managed without the need for additional surgery.

I mention these complications not to alarm or frighten you since the usual outcome after this surgery is quite favorable. The majority of patients are very satisfied. I present this information to you to fully educate you on the side effects, undesirable sequelae and complications no matter how remote they may be.

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