Cheekbones Surgery

• Fat Injections • Mid-facelift • Malar Implants •

Fat injections (Lipofilling)

The patient’s own fat can be used to restore volume to the face. Cheekbones are not necessarily treated separately and are often included during facial lipofilling.

The lipostructure technique or Coleman lipofilling involves removing fat by liposuction from areas where there is an excess of fat and reinjecting it into the face. In most cases, excess fat from the knee, when it is present, is used because of its good quality.

The fat removed must be purified by centrifugation, filtration or decantation before being re-injected. The micro suction tubes used are specially designed for the face (microtransfer of fat). All steps take place during the same operation (collection, purification, re-injection).

The rate of engraftment is excellent on the face and limited “over-correcting” is needed. Therefore only a little more fat than necessary is injected to achieve the desired volume. When the loss of fat is greater than expected, a second session several months after the first procedure or additional injections of hyaluronic acid may be necessary.

The result is permanent after the partial reduction phase is completed. However, the volume of fat grafted will fluctuate with any significant weight change.

The advantage of this technique is the natural and definitive characteristic of the fat transfer with no scarring.

Ideally treats

For the face, the fat grafting ideally treats :

  • increased volume in the cheekbones ;
  • correction of dark circles and tear trough ;
  • the augmentation of the eyebrow fat pad (Charpy’s pad) ;
  • filling hollow temples ;
  • correction of flat forehead ;
  • augmentation of the chin ;
  • filling hollow cheeks.
Associated procedures

This fat transfer can be performed individually or in addition to a facelift and / or eyelid surgery.

Procedure

In most cases, the procedure can be performed under local anaesthesia as an outpatient

Scars induced by lipomodelage are almost non-existent and limited to several 1 mm incisions.

Postoperative effects
Limited pain is experienced after the procedure, however some swelling and bruising can occur for 2 to 3 weeks.
The final result is visible after 6 months.
Risk of complications
As with any surgery, there are risks of complications although statistically very low.
Hyaluronic acid or fat ?

Hyaluronic acid and autologous fat injections are two techniques that treat the same condition (face, hands, body), with the exception of breast augmentation, as the breasts should not be injected with hyaluronic acid. Both procedures have their advantages.

Hyaluronic acid provides an instant effect without anaesthesia directly at the doctor’s office. But its effect is reversible and the correction of large volume loss can be costly.

Re-injecting the patient’s own fat is 100% natural and can be performed under local or general anaesthesia in the operating room. The result is permanent.

Mid-facelift (cheekbones, dark circles under the eyes, folds)

The mid-facelift or centro-malar facelift aims to reposition the facial tissue located between the eyes and the mouth (midface) to their proper place.

Over time, the tissues of the mid face literally droop. The result is a hollowing under the eyes, elongation of the lower eyelid with a tendency to create a round eye (disappearance of the almond shape), a loss of volume of the cheekbones, the formation of nasolabial folds and marionette lines and the appearance of puffy lumps on either side of the chin making the face appear square (jowls).

The centro-facial lift, amongst other procedures, makes it possible to restore plumpness to the cheekbones, by lifting the sagginess incurred by ageing.

Guidelines for the procedure

The surgeon makes an incision just below the eyelashes of the lower eyelid (sub-eyelid incision) identical to that used to remove excess skin in the lower eyelid.
From that incision, all the soft tissues of the cheek are detached from the bone to be repositioned higher in a movement opposite to that caused by ageing.

Invisible facial threads are attached through small perforations in the cheekbone (palpable bony arch under the eyes).

At the end of the procedure, excess skin of the lower eyelid is removed.

The procedure is performed under general anaesthesia. The duration varies between 1 and a half hours and 3 hours. Hospitalisation is 24 hours.

Associated procedures

All other methods of facial cosmetic surgery may be associated with a centro-facelift according to patient needs.

  • A liposuction of the neck and certain areas of the face.
  • It is also common to perform eyelid surgery at the same time with or without a temporal lift.
  • Certain facial muscles can also be remodeled. In particular, the Depressor Anguli Oris muscle (DAO) can be cut through two 1 cm incisions located in the mouth, which allows the downward pull of the corners of the mouth to be removed. This particularly sad aspect of the mouth (marionette lines) is rarely considered by surgeons.
  • An upper lip lift also helps restore the mouth to its original expression.
  • A traditional facelift can be proposed in addition to the centro-facial lifting. This technique is performed either during the same operation, or more frequently during a separate procedure.

Non-surgical techniques are also often considered in addition to a mid-facelift:

  • Botulinum toxin injections or hyaluronic acid injections can be performed during surgery if the injection site is different from the surgery site. Otherwise, the injections are given 15 days before or after surgery.
  • Electro-rejuvenation (Timed) or dermabrasion are used to correct fine lines located at the upper lip.
  • A glycolic chemical peel (light superficial peel) or TCA trichloroacetic acid (medium peel) can be performed on the day of surgery and improves the complexion and radiance of the skin, removes pigmented marks and blemishes, and reduces fine lines.
Post-operative effects

After discharge from the clinic no dressing is required. Applying ointment to the scars is sufficient.

There is almost no pain that is relieved by appropriate analgesics. A feeling of pressure and tight skin is normal during the first couple of days.

The after effects are characterised by edema (swelling) of the face and ecchymosis (bruises) of varying importance depending on the patient and disappear during the first 2 to 3 weeks. It is necessary to wait 3 to 6 weeks for the results of the procedure to be unnoticeable. The edema of the lower eyelids sometimes takes a little longer to disappear.

Hardening and decreased sensitivity of the lifted sites or the upper lip may persist for 1 to several months.

Outcome
The result is natural. The face doesn’t appear to be either frozen or surgically enhanced. The facial features give a fresh, rested and relaxed look. The scars are very discreet, sometimes pink for several weeks but are easily camouflaged with makeup. They are unnoticeable after 3-6 months.
Risk of complications

As with any surgery, a number of complications can occur. But the likelihood of these complications is reduced in the hands of a qualified plastic surgeon and in the presence of a competent anaesthetist. The patient’s compliance to instructions given by the surgeon is also essential and include:

  • stopping smoking 1 month before and after the procedure (reduction of all risks);
  • not taking aspirin for 10 days before and after the procedure (reduced risk of hematoma).

Fortunately, postoperative effects are generally manageable following a mid-face lift that has been carried out properly, so serious complications are rare.
Rare complications that could occur include, but are not limited to risk of hematoma, infection and temporary skin sensibility.
In the event of a complication, appropriate measures will be taken.
In practice, the vast majority of cases take place without any problem and the patients are satisfied with the result.

Health insurance coverage
As this procedure is considered purely for aesthetic purposes, no coverage is provided by health insurance.

Malar implants

Malar implant surgery increases the volume of the cheekbones correcting congenital or age-related malar hypoplasia.

The results are durable as long as the implants are in place, and reversible since the implants can be removed at any time.
Different types of implants

There are different types of implants:

  • depending on the shape of the implant, the projection of the cheekbones can be done according to the method chosen during the consultation. Thus, the surgeon can opt for a higher or lower cheekbone placement on the face.
  • depending on the size of the implant, the results can vary between very discreet to very pronounced.
  • depending on the material used to make the implant:
    • malar implants can be either silicone coated with or without polytetrafluoroethylene PTFE. These are flexible and can be inserted through small incisions and are easy to remove if needed. There is a wide choice of silicone implants available, to adapt to all situations.
    • porous polyethylene (MEDPOR) implants are partly integrated into the bone. Their placement is a little more restrictive compared to silicone implants, as they must be inserted through larger incisions and screwed to the bone. Over time the bone resorption with this type of implant is very low, as opposed to silicone implants where resorption is more noticeable. Their withdrawal is delicate.
Principle of the placement of malar implants

Implants are introduced through a one centimetre intraoral incision on each side of the upper gum, under general anaesthesia and on an outpatient basis.

Implants are placed in contact with the bone and fixed by wires or with micro-screws.
The incisions are then closed with absorbable sutures.
A post surgical compression mask is to be worn for 24 hours.

Post-operative effects

The after effects include an edema on the face which disappears in 2 to 3 weeks. The pain is mild to moderate.

Result
The appearance is very natural if the chosen implant is well suited to the patient in terms of shape and volume.
Risk of complications

As with any surgery, a number of complications can occur. But the likelihood of these complications is reduced in the hands of a qualified plastic surgeon and in the presence of a competent anaesthetist. The patient’s compliance to instructions given by the surgeon is also essential and include :

  • stopping smoking 1 month before and after the procedure (reduction of all risks) ;
  • not taking aspirin for 10 days before and after the procedure (reduced risk of hematoma).

Fortunately, postoperative effects are generally manageable following a malar implant that has been carried out properly, so serious complications are very rare.
Rare complications that could occur include, but are not limited to risk of hematoma, infection and temporary skin sensibility.
In the event of a complication, appropriate measures will be taken.
In practice, the vast majority of cases take place without any problem and the patients are satisfied with the result.

Health insurance coverage
As this procedure is considered purely for aesthetic purposes, no coverage is provided by health insurance.
Chirurgie esthétique des pommettes à Cannes - Dr Laveaux

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