Your Questions

Q: Dr. Eppley, Thank you for getting back to me so quickly in regards to my cheek implant removals.This has been such a nightmare and I just want to let you know how appreciative I am of your time. I had small malar/submalar implants put in one year ago. In hindsight I did not need the implants. I felt the implants were sharp and didn’t go with my soft delicate features. I waited for six months and then had them removed.

Now I have a whole new set of problems. I now have stretched out skin and sagging nasiolabial folds ( I think it’s my cheek collapsed) that are making me look much older and less beautiful than I am. I have attached a photo of me before and after removal so you can see what’s going on. I am considering having implants put back into my face as one option. Please let me know if you have any thoughts and or suggestions. I read your article about cheek suspension in situations similar to mine and I am hoping you may be able to help me.

A: Thank you for sharing your story of cheek implants and subsequent cheek implant removals. The sequelae from their removal is common and makes biologic sense since the implants disinsert the bony attachments of the overlying cheek soft tissues. Once the implants are removed, the overlying cheek tissues slide downward creating the effects you now see. Given that it has been six months since your cheek implant removals, you now have a good feel of how you look and whether you can live with the tissue changes.

Improving the fallen cheeks comes down to three options; 1) put back in new cheek implants, 2 ) do fat injections instead of cheek implants or 3) perform cheek resuspension.  All three cheek restoration approaches have their advantages and disadvantages. The easiest is volume restoration through either new cheek implants or fat injections. Cheek implants would be more effective than fat injections for a variety of reasons. Cheek resuspension is always more appealing as it directly treats the actual problem but it is more unpredictable and is best done through a lower eyelid incision. Given your young age and what you do professionally, I would be hesitant about any external incisions on you no matter how well they may heal. Intraoral cheek suspension avoids this external scar concern but is far more challenging to do. The Endotine cheek/midface lift is one device that helps successfully execute the cheeklift procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am wondering if you could perhaps further explain how exactly a cheek lift lasts – and by that I mean how it permanently elevates the cheeks? I am confused on how it works. You mentioned that the tissues are elevated and suspended. Are the sutures used always dissolvable, or are they sometimes permanent? 

It is assumed that during the months following the cheek lift, the tissues reattach to the bone in a higher position. Is this inevitable and natural for the body because of the sutures lifting the tissue or can it ever “not” happen ? Do some of the tissues ever not reattach in the upright position over that period? 

After the sutures dissolve over a period of time (assuming dissolvable sutures are used), what ensures that the tissues just do not fall back down? What if some did not attach before the sutures dissolved?

The second doctor I consulted with stated that since in his experience he has never re-done a patient’s cheek lift and he has been doing them for thirteen years, it should last me a minimum of ten years. He stated that I will age at a natural rate after the cheek lift. However, I have read dissimilar answers on Realself where other doctors have stated that it can last a mere 3 years! What is your general estimate on longevity? Would I age any faster or would my tissues fall faster having had the cheek lift done or are the effects of aging unknown?

A: The exact lifespan of any cheek lift can not be precisely predicted and is dependent on why it was done, age of the patient, how they genetically age and the technique used. Thus no average number of years can really be accurately stated for cheek lifts.

A cheek lift is a subperiosteal tissue elevation and resuspension. (which makes it quite different than that of a facelift for example and ore similar to that of a browlift) In theory, its initial stability is held by the sutures but the healing of the tissues is ultimately what holds it elevated. Therefore the use of permanent sutures offers no advantages long term over dissolveable sutures and runs the risk of suture reactions later if non-resorbable sutures are used.

Once the cheek tissues have healed, how they age is going to be reflective of the natural aging process of the patient and how the cheeks may have aged (dropped) had the procedure not been done. Think of a cheek lift as restorative to what you were before the cheek implants. How the cheeks may age could be better than had nothing ever been done since they would be further elevated than had the cheek implants never been placed.

Dr. Barry Eppley

Indianapolis, Indian

Q:  Dr. Eppley, I am 38 years old and have had very noticeable nasolabial folds for the past several years. I have had injectable fillers, specifically Juvederm Ultra XC, placed into them with some improvement. I also had my cheeks injected also. Now, less than 6 months after the injections, my nasolabial folds are just about back again. I would like to something that is more permanent and may even have a greater effect. Do you think a cheek lift will work? Or should I just wait until I am older?

A: Deep nasolabial folds at a young age can be a very difficult problem. Some facial shapes and skin types are simply more prone to them and, if this is an issue at the young age of 38, it is going to continue to be a long-term facial issue. Injectable fillers for the nasolabial folds offer both advantages and disadvantages. Their advantage is that they work when properly placed. There is great debate of the many fillers as to which one is better but none has ever been shown to be really be ‘better’, they all work. Some simply last longer at a greater price. They work instantaneously and generally have no significant problems. Their disadvantage is that they are not permanent. No injectable filler is permanent, no matter what is said by some. However, a cheek lift is not the solution either…for now. You are too young to justify such surgery and it is not a permanent solution either. You would be best served to continue with injectable fillers at this point even though they have limited duration. The effectiveness of cheek or midface lifts depends on mobility of the cheek tissue across the zygoma or cheekbone. I doubt if you have much of at your age. This is why such cheek lifts are years away for you.

Dr. Barry Eppley

Indianapolis, Indiana