Cheek-lift is Pre-emptive Strike Against Aging Face:

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.

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."

"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.

• 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