This 48-year-old, Dallas woman complained that in recent years her cheeks had sagged making her look tired. She also didn’t like the jowls that had formed along her jawline or the loose skin on her neck.

We performed a full facelift including, an Endotine midface lift, a jowl suture lift, a neck lift, and an Endotine endoscopic browlift.

Notice how this facelift technique restores gentle fullness in the upper cheekbones. The jowls are gone and the neck is smooth. This is the soft look of youth.

This 37-year-old was concerned mostly with her puffy lower eyelids and what she described as “non-existent cheeks.” Sure enough, her exam showed that she did have small cheekbones and, interestingly, it was her small cheekbones that caused the other problems.

The cheekbones are the floor that the lower eyelids sit on. When the cheekbones are prominent, the floor is sturdy and the eyes age slowly. But when the cheekbones are small, the lower lids have no floor to support them; they stretch and sag and drop much earlier in life. People with small cheekbones often come in to get their lower lids done as early as their 20′s. And it’s a mistake for a plastic surgeon to just fix the lower lids for these patients. That doesn’t correct the real problem so the results never look that great.

There’s another problem with small cheekbones. The cheekbones hold up the soft tissues of the cheeks and, when they’re small, the cheeks also sag early. That’s what happened here.

Knowing the anatomy of the problem made the solution clear:

1. Build up the cheekbones with cheek implants. This balances the shape of the face and creates support for the lower lids and the cheeks.
2. Lift the sagging cheeks with an Endotine midface lift.

The end result is a soft, natural fullness in the upper cheeks that tapers downward to the jaw. The shape of her face is prettier.

A couple of other points worth noting:

• Her lower lids look better even though I didn’t do any procedures on them. This is often a nice added benefit of the midface lift. Shifting the cheeks upward shortens the height of the lower lids and makes them look younger.
• I did put in a small chin implant to improve her jaw shape. But that’s a whole different subject for another post.

A standard facelift would flatten her cheeks even more – exactly the opposite of what we wanted. Instead, I did a three-level facelift to rejuvenate and restore her facial shape.

I started with an Endotine midface lift. This returned the sagging cheek tissues back up onto the cheekbones. Next, I suture tightened the lower facial fat to eliminate the jowls.

The final step was a gentle skin tightening through a modified facelift incision. This is unlike the forceful skin pulling done in conventional facelifts. Because we have already raised the cheek tissues and tightened the fat, I don’t need to pull hard on the skin to try to move those deeper structures. All that’s needed a conservative skin removal to get of any looseness on the cheeks and neck.

After healing, she looks younger and prettier. The result looks natural – not operated.