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
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
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.
fullness of the cheeks, or rounded, shapeless
4.) Puffy areas in
the cheeks most often in the shape of almonds or
5.) Lines or folds
from the cheek that cross the jaw-line, often called
How is cheek sculpturing surgery done?
It is done through
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.
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
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
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
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
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
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
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.
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
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
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
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
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.
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
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?
surgery is rarely covered by insurance.
How long does the operation take?
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 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.
there any scars?
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
We can almost
always eliminate any visibility of scars if they do
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?
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
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