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What is surgery of the cheeks?

Surgery of the cheeks is done for the purpose of improving the contour of the cheeks. It is “sculpturing” of the cheeks. 

Changing the shape with surgical sculpturing can be permanent. It can last for decades. 

Just pulling the facial tissue up and back without actually surgically changing the facial contours (as is done with a face-lift) is temporary and may not last two years. In a short time, all the cheek lines and folds return. 

In a questionnaire of persons who were considering face surgery, the majority had problems with lines or folds or the shape of the cheeks, and these concerns held the highest priority for these patients. These problems were the most bothersome or noticeable aspects of their face, the ones they most wanted corrected.

The cheek problems noted by many patients were as follows:

1.) Deep folds from the side of the nose down to the corners of the mouth - called naso-labial or cheek folds. 

2.) Lines from the corners of the mouth down to the jaw line - called oro-mandibular lines or marionette lines. 

3.) Excessive fullness of the cheeks, or rounded, shapeless cheeks.

4.) Puffy areas in the cheeks most often in the shape of almonds or fortune cookies.

5.) Lines or folds from the cheek that cross the jaw-line, often called jowls. 

 

How is cheek sculpturing surgery done?

It is done through the mouth.  

Or if skin tightening is needed, it is done through the incision that is used for that purpose. 

This may be an incision hidden in the hairline in the temple area, behind the ear, through the inside of the lower eyelid, or a hidden, invisible face-lift incision. 

The exact technique depends on the face, the problems to be corrected, the chosen goal from our examination, or from the drawing plans that are chosen by the patient. 

When the cheeks are repositioned and are to be gently held in place, some suturing can be done with permanent sutures. 

Cheek soft tissues are repositioned and some tissues may be removed, and some may be augmented or made more full with tissue implants. 

Sometimes the face is improved with implants in the cheekbones. These are made of silicone rubber or Teflon, but substances such as nylon and other FDA approved materials (i.e. certain types of polyethylene, polyamide, or acrylic) can be used to give a more attractive contour to the face. 

 

How much improvement can one expect?

Generally this can be seen in the pictures of the cheeks that are shown on the website, as well as the many other photos that we can show in the office that are not on this web site. 

But in your specific face the best answer is to see the improvement in advance. Looking in the mirror with the doctor and holding the tissues of the face in more attractive positions is the standard traditional way of seeing how much improvement can be obtained in the face. This is done by holding the cheeks tissues up and back, or in whatever position looks best. 

We also answer this question for each person with drawings. The drawings should be of good enough quality that the improvement can be clearly seen. It would be much like trying on clothes; you can see how good they look on you before you buy them. 

And with the drawings, the person can take them home, hang them up on he wall, and look at them when in different moods. And get the opinion of others as to which looks best or how much improvement there is. 

Then there is the question of how close to the drawings the post-surgical appearance is. You can see the answer to this question for yourself by looking at any of the thousands of photographs of befores and afters and comparing them to the patients’ chosen drawings. 

We also have the opinions of hundreds of our patients who have had work done. A majority of our patients say that the results equal or exceed the drawings. You may see hundreds of these questionnaires and the summaries of the answers to these questions. 

Anything that can be done with the fingers on the face such as lifting up and back or lifting eyebrows or the corners of the eyes up and back can be done with surgery. So this acts as a preview. And even without drawings, most doctors look in the mirror with the person and discuss the changes and improvements in the mirror. Often it is good to see that you and the doctor agree more or less on what is possible and most advantageous. 

The drawings have the advantage over looking in the mirror in that they can take more details into consideration, show more at one time, and are more objective in that they can be studied and critiqued by anyone, anytime, and anywhere even without the subject being there. And they are much more permanent. In king Tut's tomb, the drawings would have lasted thousands of years if the tomb had remained undisturbed. 

There is permanent improvement and temporary improvement. It is a good thing to emphasize and plan for the permanent things of shape and form over temporary changes. 

The standard, traditional face-lift is mostly temporary compared to the many changes that can be made and chosen in drawings that are permanent. We can make many persons appear permanently younger and more attractive without a face-lift. And these methods can be explained to each person and shown to them in drawings. 

The amount of improvement is quite different for each person. The best estimate is with drawings. Looking at a lot of the results of surgeons’ works in before and after photographs is a very good way of getting a general idea of what can be done. Beware of retouching of photos, especially those that are digital. Seeing actual film prints, slides, and negatives in a doctor’s office is more of a sure thing. 

How long will the improvement last?

With the cheeks, the pictures show two and three year follow-up pictures. And we have photos in the office of some patients with 20-year follow-up. But they have usually had other nips and tucks in addition to the cheek work over the years. 

And yet a new shape of the cheeks, just like a new shape of the nose or chin, and be permanent. 

Those things of the face that are changed in shape such as the nose, cheeks, chin and even the eyelids and removal of bags of the eyes are very long lasting or even permanent. 

Those things that are accomplished by tightening and repositioning the skin are much more temporary. It is the case that tightening the skin of the face with a standard face-lift by itself may take 5 to 20 years off the persons appearance in age. One way to express how long it will last is to say if it takes 10 years off, the person will always look 10 years younger than if they had not had it done. Therefore, it will take 10 years for their appearance to catch up to what it was in the beginning before anything was done. 

According to the above formula, however much younger a person looks in years is how long the results will last. On the other hand, even the tightening up or face lift is permanent in the sense that the person who looks 5 or 10 years younger will always look that much younger, no matter how many years go by. 

No operation can permanently prevent aging, but the individual will never appear as old as he might have if the operation had not been done. The exact duration of improvement can be most accurately predicted with drawings that show the expected result. 

In Summary: The improvement is permanent in terms of change of shape and structure, such as can be done with the chin, under the chin, nose, etc. Some looseness of the skin always returns. If a person is made to appear five or ten years younger, then they should always appear that much younger than if they had not had the surgery. This effect is cumulative, in that if a person has two or three procedures, each causing them to look five years younger over a period of time, they may look a total of fifteen years younger as a result.

How is the surgery done?

The surgery is performed with the patient in a twilight sleep. The patient is given sedatives, tranquilizers and medicines to prevent any feeling of discomfort. Our anesthesia questionnaire shows that more than 94% say they had a pleasant experience.

With the person comfortable and mostly sleeping soundly, the work is done as planned with small sterile instruments made for this purpose. All of the instruments and equipment used are sterilized. 

While surgery is in progress the person is connected to a pulse oximeter, automatic vital signs monitor, and electrocardiograph. But most important of all, the person is always under direct observation of the surgeon and his nurses and assistants. 

Where is the operation performed?

It may be done in the federally approved, Medicare certified, outpatient surgery center of our office, or in the hospital. Most persons choose the office because it is more convenient and it offers greater privacy and safety with less chance of infection, and patients can avoid the added cost of a hospital bill.

We have had an occasional patient have consultation and laboratory work at the hospital both before or sometimes after a surgical procedure. 

But from the surgeries performed in our outpatient surgery center over the course of thirty-plus years, we have had a perfect safety record and there have been no emergencies.

Is there much swelling or bruising?

There is some bruised appearance in nearly every case. Usually this can be hidden by make-up within a few days or in one or two weeks. It is mostly gone in three weeks. Many procedures can be done without bruising.

Is there much pain?

No pain should be felt during surgery. After surgery there is a feeling of tightness and tenderness of the area for a few days. Our anesthesia questionnaire that has been filled out by every patient after surgery over the course of many years is available for your information. It shows that well over 90% are pleased with the experience. 

Will insurance pay for this kind of surgery?

Strictly cosmetic surgery is rarely covered by insurance.

How long does the operation take?

Careful surgery may require several hours.

Are bandages worn on the face?

In most cases no bandages are needed. If they are used, they will be removed the second day following surgery. We find that little plastic drains that cannot be felt by the person are much more comfortable than bandages when needed. 

When are the sutures removed, and is this painful?

Some sutures are removed within the first week. Some sutures are removed each time you are seen over a period of one to several weeks. There is no real pain with suture removal. Each suture removed may feel like one hair being plucked from the head and should not even feel that much. Usually there is no sensation or just a tickle with suture removal. 

Are there any scars?

Cosmetic surgery should produce no scars and no signs that it was ever done.  The location of the incisions can be drawn on the patient to show where they will be. Most patients heal well and do not have any visible scars.

We can almost always eliminate any visibility of scars if they do occur. 

Must some of the hair be shaved? Is any hair lost?

No hair is shaved, and no hair is lost. Very rarely, there is a low forehead hairline that is wished to be set back. 

Yet some surgeons still make incisions behind the hairline and routinely remove precious hair. This eventually leads to what is referred to as bald face, which is a hairline that is pulled back too far, resulting in hair loss and a long distance from the hairline to the eyebrows and eyes. Many celebrities who are over forty and up have this condition - and amusingly, some who even deny ever having had surgery. 

How long is the recovery period?

The average recovery is as follows: On the first or second day after surgery the drains are usually removed. If any bandage was applied, this is removed on the second day. On the fourth or fifth day some sutures are removed and make-up may be applied. Post-op visits to our office are quite frequent in the first two weeks to make you as comfortable as possible during your recovery.

How long before I will be presentable in appearance after cheek surgery?

Usually one to three weeks is required for sufficient healing. The patient should expect noticeable signs of surgery in the first week. With proper make-up after the second week, most strangers you meet will not be able to tell any surgery was done. In two to three weeks, patients often wish to return to work. Complete healing may require four to six weeks or more.

We have several sets of very informative pictures donated by our patients that show how they progressed through having the face and eyes and other procedures done. You may wish to see them here on the website.

 

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 William Roy Morgan, M.D., F.A.C.S  Last modified: January 22, 2015