Mid Facelift & Malar Fat Pads?

Dr. Dean Kane Q & A  Q. How does a mid facelift address the Malar fat pads in cheek (if at all)? A. The following is re-posted from: Bryan Mendelson, FRACS, FACS, Melbourne, AU,  Plastic Surgeon who I thought wrote a terrific explanation of the Mid-Cheek enhancements and Lift: The mid cheek is the area of the cheek under the eyes, between here and the upper lid is. It is a most visible and important part of the face and when just right gives a positive healthy, attractive and youthful  look to the face. Just think of the actress, Cate Blanchett. Unfortunately, some people, usually for hereditary reasons, do not have a well developed bone structure of their mid cheek. This automatically limits their attractiveness and predisposes the person to the tired look of premature aging. The fat layer under the skin here is called the malar fat pad and is thicker than elsewhere. If not projected forward by good bone structure the fat pad soft tissue, tends to sag; at least it looks that way. A mid face lift is performed through the lower eyelid, which is usually involved in the premature aging, forming lid bags and so this is corrected as part of the cheek correction below. The direction of lift of a mid cheek lift is purely vertical, so the benefit is localised to the mid cheek and it does not benefit below and to the side. In my experience this procedure is indicated for people who have most of their aging in this important area, and the deficiency of bone structure is corrected at the same time by using a cheek implant. Although factory made, synthetic implants of silicone and porex are most often used and are very good, but my preferred implant material is coral, which is naturally occurring. I have used this in the mid cheek correction of over 600 patients because I like its biology and the flexibility to individualise.The coral used is microstructurally identical to facial bone and  purified to become hydroxyapatite, the mineral of bone. The coral comes as small granules, which the surgeon places on the surface of the deficient bone and moulds it to the desired shape for the individual persons face. Obviously the shape is different for women and men and has to aesthetically balance with the other facial features. Over time the persons own bone grows into the coral implant so there is not any concern about any problems of infection or rejection in the long term. So if someone has that bone deficiency a permanent correction is obtained . However, more often the midface deficiency is part of overall facial aging. With the advances in facelift surgery, it is now possible to add a good midface lift with the facelift so the whole face is refreshed. The cheek implant augmentation can also be performed through the facelift and surgery on the lower lid not required. This has the advantage of avoiding the slower healing associated with full lower lid surgery. The vector of tightening of the facelift on the mid cheek is up and also out. You can see the benefit of this direction of lift when pulling your cheek in this direction as you look in a mirror. This direction optimises the ‘lift’ over the cheek implant and has most benefit on the laxity of the malar fat pad. As with any cosmetic concerns, consult with a Board Certified, well experienced Plastic Surgeon for evaluation and recommendations.
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