Cheeklift Procedure
The Superficial Cheeklift
A fast recovery technique for rejuvenating the lower eyes and cheeks
Click Here to see the USIC (Ultrashort incision cheeklift) Procedure Graphic
Click Here to see the LiveFill® procedure Graphic (lips and cheeks)
Click Here to see the Neck-Lace Graphic
Click Here to see the LiveFill® procedure Graphic (multiple areas)
Click Here to see the 360 Facelift® Procedure Graphic
Click Here to see the Graphic of the Depressor Anguli Oris release (DAO Release)
Background
Dr. Moelleken innovated this procedure. He has presented it at many national and international plastic surgery meetings. Details of the technique can be found in many of Dr. Moelleken’s articles and book chapters on this subject, most of which are available in their entirety under “Articles” on this website.
The Problem
People in their 40's and 50's may start to notice a tired look below their eyes. Often, fat bulges and an unrested, sagging appearance occurs. Conventional lower eyelid surgery, whether performed with a laser or scalpel, removes skin and fat from the lower eye. This can cause a hollow, pulled look.
The Technique
The superficial cheeklift is a new technique. It involves raising up the midface underneath the eye. No implants or plastic are used. The unique feature of this operation is that the cheekpad is tied with invisible stitches to very tough tissue beside the eye, and doesn't rely at all on the very weak lower eyelid. The recovery time is about the same as for the lower eyes. Most patients are back to deskwork after a week or less. The superficial cheeklift uses an incision hidden just below the lower eyelashes. All the remaining stitches are buried under the skin.
Problems with Conventional Lower Eyelid Surgery
When people have their eyes done, they frequently develop a frightened, "deer in the headlights" look. This may result from the fact that the lower eyelid is very weak and cannot support weight. Therefore, if the doctor attempts to remove skin from below the eye, the lower eyelid can pull down or develop a rounded appearance. Patients of conventional lower eyelid surgery often complain that the, “don’t look the same”. Dr. Moelleken has found that the superficial cheeklift can correct this problem on patients who have already had eye surgery and noticed that their eyes were pulled down and somewhat hollow appearing.
The Natural Look
Often, the first signs of aging in the face often occur in the eye and cheek region. The superficial cheeklift elevates the cheekpads and rejuvenates the lower eyes. This differs from a conventional facelift, which only pulls tissues to the side. The midfacial area and lower eyelids cannot be rejuvenated through a conventional facelift incision. A windswept, unnatural "too tight" appearance may result if that is attempted. When performed at the same time as a facelift, the superficial cheeklift avoids this by elevating the cheeks, rather than by pulling them to the side. The result is a more natural rejuvenation.
Who is a Candidate?
The superficial cheeklift is especially for people who have a baggy, droopy appearance of the lower eyes and cheeks. Usually this problem starts in the late 30's and 40's and is pronounced by their 50’s.
Alternatives
The midface is one of the most complicated areas in plastic surgery. For a complete discussion of all available techniques and applicable anatomy, please see Dr. Moelleken’s chapter in the textbook “Plastic Surgery (ed Mathes, Saunders, 2006)”, an 8-volume textbook that is the most authoritative in the world on plastic surgery. A copy of this chapter is available on the website drbrent.com under “Articles” or through Dr. Moelleken’s office. Dr. Moelleken also offers various endoscopic, temporal, suture suspension, pretrichial, volume enhancement, etc. options in his practice when the anatomy of the patient dictates.
Risks
As with any surgery, there are risks. The patient must be in good health to undergo any elective surgery. The risks of the superficial cheeklift are low - about the same as having the lower eyes done. The cost, including anesthesia and operating room, is about half that of a conventional facelift.
Dr. Moelleken has appeared on numerous national television broadcasts, and has published many articles and book chapters on this subject. You can see exact transcripts of these TV appearances and articles on the his website drbrent.com.
The Anesthesia
The Cheeklift is typically performed under a "light" general anesthetic (patient is lightly asleep), however it can readily be performed under local anesthesia or under IV sedation.. This technique provides excellent operating conditions while affording maximal patient comfort and safety. In Dr. Moelleken’s practice, all anesthetics are administered by a board certified anesthesiologist (physician) who remains in attendance throughout the operation. All appropriate monitoring, anesthesia delivery and emergency equipment are present at all times. Further information, including any questions you may have, will be explained and discussed fully by our anesthesiologist prior to your surgery.
Pre-Operative Preparations
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work will need to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to local doctors in our area. We do not provide these services. It will be required that all this pre-op paperwork is in our office 1-2 weeks prior to surgery.
It is very important that our office is aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 2 weeks prior to surgery, and 2 weeks after surgery. This would impede your healing greatly. Talk to us about options.
It is a requirement that someone drive you home upon your discharge. Also arrange for transportation to and from our office for your post-operative appointments until your doctor gives you permission to drive.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior to surgery and for 2 weeks after surgery.
An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.
If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods.
What to Expect after Surgery
Activity:
Post-operatively the patient is encouraged to ambulate soon after surgery, with frequent periods of resting.
Pain:
There is a minimal to moderate amount of pain associated with this type of surgery. Medication is available to control any discomfort experienced while in an after-care facility or at home. Coughing, laughing, sneezing or other anything that exerts pressure will produce discomfort post-operatively.
Dressings:
Thin skin color steri-strip tapes are applied to incisions.
Scars:
The scars left by this procedure are generally predictable and although they fade with time, they are permanent. Occasionally, a scar revision procedure is necessary to attain the best cosmetic result. These procedures are minor and can be carried out in the office under local anesthesia.
It is not unusual for a patient to experience a period of the "blues" during the convalescence. This is temporary. It's helpful to remember that it is impossible to judge the final result of your surgery until all of the swelling has subsided and the operative area has smoothed out.
Post-Operative Care
It is important to apply ice compresses to eyes with an ice mask, or frozen peas in a small Ziploc bag for the first 24-48 hours. Avoid putting cold plastic directly on your eyes by using a soft cloth as a barrier. This will minimize swelling and bruising.
Follow instructions for eye drops and eye ointment as directed. Be aware that ointments will blur your vision, and be cautious.
Do not get the tapes on your eyes wet for three days. The doctor or nurse will remove these tapes, and new tapes will be applied in 4-5 days.
After three days, you may shower and get the tapes wet, pat dry, but do not pull them off.
Optimal sleep position is elevated on your back with 2 pillows. A pillow under each arm, and a pillow under your knees.
AS WITH ANY FACIAL SURGERY, AVOID BENDING FORWARD, AS THIS CREATES STRAIN ON ALL INCISIONS THAT ARE HEALING.
Avoid elevating your blood pressure either by physical activity, or emotional means. This causes strain on healing areas that would increase in swelling.
After the first week of surgery, you may be given directions for eye exercises as follows:
1. Raising the lower lid- with one or two fingers, gently raise the lower eyelid and hold for 15 seconds. This can be done 4-5 times daily.
2. Squinting- squint closing the eyes tightly and hold for 15 seconds. This will strengthen the eye muscle, and also feel good.
Resumption of Physical Activities - General Rules of Thumb: Two, Four, Six Rule
First week:
TAKE IT EASY!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks:
take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks:
light exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things. Use of vitamin C and E concentrate and scar-fade gel should begin as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks:
resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyperpigmented scar.
