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The facelift has been a staple of plastic surgery for decades, helping tens
of thousands of individuals turn back the clock on aging. Wrinkles are smoothed,
jowls are tightened, youthfulness is restored and the morning meeting with the
mirror made friendly again.
Despite its ability to transform a visage, the traditional facelift is not
very effective at resolving one fundamental attribute of the aging face—drooping
cheeks that create a hollow look around the eyes and prominent lines around the
nose and mouth.
That deficiency led to the development several years ago of a technique
called the mid-face lift, which helped resolve the problem. Unfortunately, it
proved to be an involved surgical procedure and therefore was not always
practical.
When he was undergoing advanced training in Los Angeles several years ago,
Cleveland Clinic facial plastic surgeon Daniel Alam, M.D., participated in the
development of a mid-face lift technique that was not only effective, it also
could be performed using a minimally invasive approach—very small incisions
and no cutting of tissue or muscle.
Called the cheek lift and intended to resolve sagging lower eyelids, the
technique had been proposed in 1997 by an ophthalmologist, but it was used
minimally in her practice. Once he learned the procedure, Dr. Alam modified it
and began incorporating it into facelift surgery and doing so with great
results; the modified cheek lift made an effective surgery that much better.
It also soon became clear that the cheek lift—with its ability to relieve
sagging skin below the eyes and diminish lines around the mouth and nose—could
take years off a face and stand alone as a rejuvenation option. And it could
serve a growing desire among middle-aged adults for a minimally invasive
procedure that is affordable and produces results that last.
"These are adults who wouldn’t be candidates for a face lift but whose
faces are showing the initial signs of aging," says Dr. Alam, who in 2002
joined the Cleveland Clinic as the head of its section of facial aesthetic and
reconstructive surgery in the Head and Neck Institute. "They want a
procedure that erases the early signs of aging, offers quick recuperation and
gives long lasting results." The mid-face lift, says Dr. Alam, achieves
these goals.
Gravity and fat pads
The mid face owes its form in part to malar fat pads that rest beneath the
cheeks and on top of the cheekbones. Over time, gravity forces the pads to
gradually descend from their normal positions, causing hollowing around the eyes
and at the upper cheeks and droopiness in the lower cheeks. As the cheek skin
droops, it causes deepening of the nasolabial folds, the slight creases that run
from the lower portion of the nostrils and down around the corners of the mouth.
All of these changes contribute mightily to that slightly saggy, tired
expression that in many people characterizes the onset of middle age.
To counteract these effects, Dr. Alam repositions the fat pad using a simple
suspension system placed discreetly underneath the skin. A small incision on the
side of the head- between the ear and the forehead-and two tiny punctures on the
cheek provide access for needles that are used to thread very fine
sutures under the skin and through the top of the fat pad. The sutures—two for
each pad—are gently tightened until the fat pad is properly repositioned; then
it is secured at the incision site on the side of the head, to a tough tissue
plane called the temporal fascia. "This tissue is strong, so by securing
the sutures to it, we can minimize further sagging of the fat pads," says
Dr. Alam.
Repositioning the fat pad lifts the mid-face up and out, softens the
nasolabial folds, lifts and contours the jaw line and smoothes wrinkles in the
upper lip. The procedure also softens laugh lines and diminishes hollowing under
the eyes. In fact, the cheek lift produces such dramatic improvement around the
eyes that Dr. Alam says many of his patients are asked whether they’ve
undergone eyelid surgery (blepharoplasty).
"Until the minimally invasive mid-face lift was developed, manipulating
the mid-face was one of the most difficult problems in aesthetic facial
rejuvenation," says Dr. Alam. Various techniques have been devised and
used, but the procedures are involved, he says. "The only way these
techniques could affect the appearance of the cheeks was by pulling other
muscles, tissue, and skin around them," Dr. Alam says. "Because it
acts directly on the fat pad, the mid-face lift offers far more flexibility in
getting just the look the patient desires and does so far less invasively."
Quick procedure, quick recovery
Mid-face rejuvenation does not require general anesthesia or hospitalization
and costs about one-third of the price of a traditional facelift. Patients are
given sedating medication before the procedure to help them relax. The surgery
lasts approximately 20 to 30 minutes. Recuperation usually lasts about a week,
rather than the two to four weeks required following a traditional facelift.
"There is some bruising and swelling after the cheek lift but less than
what occurs with a facelift," says Dr. Alam. Generally patients are
prescribed narcotics for any post-procedural pain that might arise.
"The real key to a quick recovery is ice, ice, ice and more ice,"
says Dr. Alam. Patients can resume normal household daily activities immediately
after surgery, but should hold off on exercise or strenuous activity for one
week.
If a patient is not satisfied with the results, the suspension system can be
adjusted to raise or lower the fat pad. "I just have to cut one stitch to
affect a change, so making adjustments is quite easy," says Dr. Alam. "By
opening the incision in the hairline, I have complete access to the suture. Then
I can easily use it to manipulate the position of the fat pad. I’ll move the
pad to different positions while the patient and I watch the results," he
says. "Once we agree on the optimal position, the suture is
re-secured."
Dr. Alam says that his patients are both men and women in a wide age range,
from late 30s to early 50s. "Everyone’s face ages at different rates and
in different ways," he says, "so the age range can be broad."
Some want to look better for themselves; others believe looking younger gives
them an advantage in the workplace. Any person who has sagging malar fat pads is
a candidate for the procedure. There are no age or other restrictions.
Cheek lifts can also be combined with other cosmetic surgeries, such as
traditional facelifts or neck lifts, to give optimal results in the mid-face.
All patients who opt for a traditional facelift get the cheek lift as well, says
Dr. Alam. Even patients who have already had a facelift can undergo a cheek lift
to achieve increased smoothing of the nasolabial folds.
"Because it is so minimally invasive, the mid-face rejuvenation is a
good alternative for many people seeking a way to regain a more youthful,
vibrant appearance, " says Dr. Alam.
Tips on choosing a physician
- Verify that the surgeon is a member of at least one of three
medical boards:
American Board of Facial Plastic and Reconstructive Surgery: www.abfprs.org/
American Board of Plastic Surgery: www.abms.org/
American Society of Cosmetic Surgeons: www.plasticsurgery.org/
- Make sure the surgeon clearly explains what’s involved before, during
and after surgery and what results can be expected.
- Ask to see "before" and "after" shots of patients
the surgeon has treated.
- Be sure the physician can document background and training.
- Ask the surgeon where he/she did medical residency and how long he/she
has been performing the procedure you’re interested in.
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