Procedures
Cheek Lift or Midface Lift
The midface region is defined as the area between the lower eyelids and the mouth. The midface is an essential element of an attractive face. Prominent, full cheeks give us a healthy, youthful appearance.
A deficient cheek structure can make one’s face appear drawn and gaunt. It can cause the lower facial features to look heavy and create a hollowness in the undereye area. As one ages, gravity, repeated facial expression, and loss of collagen, cause the tissue that once draped over the cheekbones to sag. When this occurs, the cheeks begin to look flat, the face appears gaunt, dark circles begin to appear under the eyes, and the creases between the nose and the corner of the mouth deepen.
Endotine Midface Lift or Cheek Lift
The endotine midface lift or cheek lift is a minimally invasive procedure that elevates the midface up towards the eye and out toward the temple. This repositions the sagging cheek back over the cheekbone and restores the volume and natural curves of the cheeks by lifting the soft tissues back into their youthful position. An endotine is a small device with five tines or tissue graspers which gently and firmly elevate the tissue. These tines distribute the force on the tissues evenly, and can avoid dimpling or skin irregularities which can occur with conventional sutures. This is performed through an incision inside the mouth and a small incision hidden within the hair in the temple area. The soft midface tissue is elevated from the bone, repositioning it upward towards the eyes and outwards. The endotine fixes it in place until it adheres naturally to the bone. This restores fullness in the cheek volume and creates more youthful midface contours. The result is a subtle, natural, rejuvenated appearance that does not appear overdone or “worked on.” Over the next one to two months, the tissue reattaches itself to the bone. The endotine begins to gradually absorb after it is placed. Traditionally, permanent sutures were used which stayed in place long after the tissue was fixed in place. The entire procedure takes about two hours in our Beverly Hills surgery center.
When performed by an experienced and skilled facial plastic surgeon such as Dr. Aharonov, a cheek lift will present a natural but noticeable improvement. This has the advantage of a more natural appearance because the tissue is pulled upwards (often called a vertical face lift), instead of only outwards and to the sides. Depending on the patient, this can be the most effective way to correct the downward pull of gravity.
A cheek lift or midface lift can be performed with other procedures to compound the rejuvenating effect. A full facelift improves the sagging tissues of the chin, neck and jowls, which are not addressed by a cheek lift or midface lift. However, for many younger patients under 45 years old, a midface lift is often all that is needed. Our Los Angeles area patients are extremely satisfied with their results.
Cheek Implants or Cheek Augmentation
Unfortunately as we age, the shape of the Cheeks change, because the amount of soft tissue over the Cheek bone decreases and shifts downward toward the corner of the nose and mouth. With age, gravity pulls the facial tissues towards the nose, mouth and center of the neck giving the face a more angular and relatively more masculine look. As the Cheeks fall, the face has an overall gaunt and aged appearance. Hollowness appears under the eyes, dark circles appear or are accentuated, and the Cheek folds between the nose and mouth (nasolabial folds) are exaggerated. These changes begin to occur in the thirties. Cheek enhancement or cheek augmentation with an implant can correct these problems by elevating the soft tissues of the midface, thereby improving your overall appearance. Cheek implant surgery or cheek augmentation is typically completed in about an hour in our Beverly Hills surgery center.
A full rounded face is associated with youth and vitality. Hollow, sagging facial features can be associated with age, illness or even a sad or depressed emotional state. There are several ways to restore your face to its original youthful contours. A Cheek Lift or Midface Lift will elevate the face from the area of the mouth to the lower eyes. Cheek implants will also elevate the midface, but will additionally give a more rounded, defined look to your cheek bones. Dr. Aharonov is an expert at many Non Surgical Alternatives to facial rejuvenation. Facial fillers such as Restylane and Juvederm, or your own fat, can be injected into the cheek area to enhance fullness and lost volume. Facial fillers will disappear over time, some lasting up to a year. They are ideal if you want to try out your new look, before making the final decision about Cheek Implant surgery. During your consultation with Beverly Hills Plastic Surgeon Dr. Aharonov, he will evaluate your individual issues and the goals you wish to achieve. Each patient is given a treatment plan based on what is best to enhance their own facial features and degree of facial aging.
Cheek Implants come in a wide variety of shapes and sizes and can even be custom made. The cheek implants that Dr. Aharonov uses are a soft solid that have been safely in use for many years. These type of Cheek Implants can be removed at a later date if it becomes necessary.
Cheek Implant or Cheek Augmentation Surgery
Dr. Aharonov prefers to place Cheek Implants through the mouth. This approach gives an excellent cosmetic result, without a visible scar. A small incision is made inside the Cheek within the mouth just above the gums. The Cheek tissues are carefully elevated until the covering of the Cheek Bone is identified. A small area or pocket, consistent with the shape of the chosen Cheek Implant, is created. The Cheek Implant is then placed within this pocket of elevated tissue, and the facial tissues are closed with dissolvable sutures. This prevents the Cheek Implant from moving until the tissues are healed, and the Cheek Implant is secured in place. Initially, the cheeks, face or under eye area may be swollen or bruised, but this is highly variable from patient to patient. As the swelling subsides, the Cheek Implants will begin to look and feel more natural. Some degree of numbness is to be expected after Cheek Implant surgery, but this too will subside with time. All of Dr. Aharonov's Los Angeles area patients are happy with the results of their Cheek Implant Augmentation surgery.
Fat Injections:
Cheek augmentation can also be accomplished with fat injections (or with fillers). Depending on how your cheeks are, the main issue might be volume loss that is associated with aging. Augmenting your cheeks with your own fat is an easy permanent way to restore your cheeks to how they used to be. This gives you a cheek lift and can diminish the appearance of your laugh lines.
Fat is harvested from your thighs or abdomen and is specially treated to separate out the pure fat cells. This is then injected into areas of need in your face, which can include the cheeks, eyelids, jaw line, or forehead and temples. The fat injections help reverse one of the biggest contributors to aging-- volume loss in the face. Facial volume loss leads to sagging brows, extra drooping skin on your eyelids, flattened cheeks, and a poorly defined jaw line. Fat injections can help reverse all these issues. Dr. Aharonov will discuss with you all of your options in his Los Angeles area office to come up with the plan that is best and most customized for you.
Facelift Surgery
A Facelift procedure or Rhytidectomy is intended to address the effects of aging in a patient's lower face, neck and jowls. As we age, the factors of time and gravity result in a loss of facial muscle tone and skin elasticity. The cheeks begin to sag creating jowls and distorting the jaw line. Loose skin appears in the neck, often referred to as a double chin or “turkey neck.” Deep creases between the nose and mouth or below your lower eyelid may form. Facelift surgery can “set back the clock” by rejuvenating the face, improving the most visible signs of aging by removing excess fat and skin, tightening underlying muscles, and redraping the skin of your face and neck, thereby restoring your more youthful facial contours.
Beverly Hills Plastic Surgeon Dr. Aharonov favors the “deep plane” technique also referred to as a “SMAS Lift” or “Composite Lift”. Unlike procedures that simply address sagging skin, the deep plane facelift repositions the deeper underlying tissue called the “SMAS layer.” Pulling this layer taught allows the redraped skin to sit naturally in its new position. As both the skin and underlying tissue are lifted together, the tightly pulled windswept look that can accompany a facelift done improperly is avoided. It also alleviates tension on the incision lines which minimizes visible scarring, although the incisions are well hidden within the hairline behind the temples and in the natural contours of the face and ear. Fat may be sculpted or redistributed from the face, jowls and neck, and underlying tissue is repositioned. Skin is redraped over the uplifted contours and excess skin is trimmed away. Sutures or skin adhesives close the incisions. Dr. Aharonov uses the latest advances used by only a handful of surgeons which greatly minimize bruising and swelling, reduces the risk of hematoma (bleeding under the skin), and alleviates the need for drainage tubes. The overall effect is a more natural refreshed appearance than simply having tightened the skin.
During your consultation in his Beverly Hills office, Dr. Aharonov will evaluate your skin muscle, bone structure, and other specific conditions that may have contributed to your aging appearance, and then tailor the procedure to your individual needs for the best result. A Facelift, which primarily address the lower face and neck, is often combined with other facial cosmetic procedures such as a Brow Lift, Eyelid Lift surgery (Blepharoplasty), Cheek Lift (Midface Lift), Neck Lift or chin or neck liposuction in order to achieve your realistic goals. Additional procedures that may further enhance the outcome of a Facelift may include: Facial implants or soft tissue augmentation to recontour your facial structure, and resurfacing techniques (such as peels) to improve the tone and texture of facial skin. Wrinkle reduction by Botox or Dysport injection may be recommended prior to your facelift (to help underlying muscles fully relax before repositioning and tightening) or after your facelift surgery to help maintain results. Although a facelift will not change your basic appearance or stop the aging process, it will restore a younger version that will then continue to age naturally over time.
Preparing for a Cheek Lift or Midface Lift: Preoperative Information
All patients undergoing elective Beverly Hills plastic surgery procedures should be in good health. Generally, you will see your primary care doctor for a physical exam and routine lab work. This is done several weeks prior to your Cheek Lift or Midface Lift. Please inform Dr. Aharonov of any existing medical conditions, medications, previous surgical procedures, or the use of alcohol, tobacco or drugs. Plastic surgical procedures are best performed on patients that do not have any medical conditions that impair healing, and are nonsmokers.
It is very important to avoid taking aspirin and other non-steroidal anti-inflammatories such as Advil, Motrin or Aleve for one week prior to Cheek Lift or Midface Lift. These medications may cause abnormal bleeding during your cheek lift or an increase in bruising after your midface lift. A list of over the counter medications and supplements to avoid will be given to you during your preoperative consultation.
It is also essential that you disclose any medical conditions such as underactive or overactive thyroid, cardiovascular disease, high blood pressure, circulatory disorders, diabetes, blood clotting disorders, or a history of forming large scars also known as keloid scars.
It is also best to avoid alcohol and very salty foods for three days before Cheek Lift or Midface Lift to prevent your skin from retaining fluid and swelling. The night before your Midface Lift surgery, do not have anything to eat or drink after midnight in order to insure that you have an empty stomach prior to anesthesia. If needed, you may take your essential medications with a tiny sip of water in the early morning on the day of your Cheek Lift.
You should be in the most optimal nutritional state prior to surgery. An adequate diet with certain vitamin supplements such as Vitamin C is recommended. Dr. Aharonov can discuss nutritional supplements with you during your preop consult.
Anesthesia for a Midface Lift or Cheek Lift
Dr. Aharonov performs all of his surgeries in an AAAHC accredited outpatient surgery center in Beverly Hills. Board certified anesthesiologists, which are medical doctors, perform all of his cases. Dr. Aharonov prefers to have a physician caring for your anesthetic needs during surgery, as their experience minimizes the potential of unpleasant postoperative symptoms. For his surgical cases, Dr. Aharonov uses an extremely safe combination of iv sedation and local anesthetic, not general anesthesia. This technique provides superior operating conditions combined with maximal patient safety and comfort. In all likelihood, you will awaken with very little discomfort, nausea, or anesthetic side effects. In his Los Angeles area surgery center, all of the appropriate monitoring, medication and emergency equipment are available at all times. On the day of surgery, you will meet your anesthesiologist and can discuss any questions that you may have.
What to Expect After Endotine Midface Lift or Cheek Lift
After a Cheek Lift procedure in our Beverly Hills surgery center, there will be some swelling and bruising in the midface or cheek area, or even under the eyes or along the lower face. This can take several weeks to resolve, but individuals vary on their recovery time. Immediately post-op, you should use ice compresses to relieve the pain and swelling. You will be given a prescription for pain medicine and antibiotics, although most patients do not require much pain medicine after the first day or two. After one week, Dr. Aharonov will remove the sutures from your Cheek Lift in his Beverly Hills office.
You should avoid strenuous activities for a week after surgery to decrease any swelling. Most patients return to work in 10 days to two weeks. Occasionally, some patients report that they can feel the endotines when they touch their cheek area. The endotines will gradually disappear, and will not be noticeable after awhile.
Our Los Angeles area patients are extremely satisfied with the results of their cheek or midface lift. They have a more youthful appearance, without an unnatural pulled look.
Surgical Considerations for Endotine Cheek Lift or Midface Lift
Procedures:
Cheek Lift or Midface Lift Preoperative Considerations
Anesthesia for Cheek Lift or Midface Lift
Postoperative Considerations for Midface or Cheek Lifts
The midface region is defined as the area between the lower eyelids and the mouth. The midface is an essential element of an attractive face. Prominent, full cheeks give us a healthy, youthful appearance.
A deficient cheek structure can make one’s face appear drawn and gaunt. It can cause the lower facial features to look heavy and create a hollowness in the undereye area. As one ages, gravity, repeated facial expression, and loss of collagen, cause the tissue that once draped over the cheekbones to sag. When this occurs, the cheeks begin to look flat, the face appears gaunt, dark circles begin to appear under the eyes, and the creases between the nose and the corner of the mouth deepen.
Endotine Midface Lift or Cheek Lift
The endotine midface lift or cheek lift is a minimally invasive procedure that elevates the midface up towards the eye and out toward the temple. This repositions the sagging cheek back over the cheekbone and restores the volume and natural curves of the cheeks by lifting the soft tissues back into their youthful position. An endotine is a small device with five tines or tissue graspers which gently and firmly elevate the tissue. These tines distribute the force on the tissues evenly, and can avoid dimpling or skin irregularities which can occur with conventional sutures. This is performed through an incision inside the mouth and a small incision hidden within the hair in the temple area. The soft midface tissue is elevated from the bone, repositioning it upward towards the eyes and outwards. The endotine fixes it in place until it adheres naturally to the bone. This restores fullness in the cheek volume and creates more youthful midface contours. The result is a subtle, natural, rejuvenated appearance that does not appear overdone or “worked on.” Over the next one to two months, the tissue reattaches itself to the bone. The endotine begins to gradually absorb after it is placed. Traditionally, permanent sutures were used which stayed in place long after the tissue was fixed in place. The entire procedure takes about two hours in our Beverly Hills surgery center.
When performed by an experienced and skilled facial plastic surgeon such as Dr. Aharonov, a cheek lift will present a natural but noticeable improvement. This has the advantage of a more natural appearance because the tissue is pulled upwards (often called a vertical face lift), instead of only outwards and to the sides. Depending on the patient, this can be the most effective way to correct the downward pull of gravity.
A cheek lift or midface lift can be performed with other procedures to compound the rejuvenating effect. A full facelift improves the sagging tissues of the chin, neck and jowls, which are not addressed by a cheek lift or midface lift. However, for many younger patients under 45 years old, a midface lift is often all that is needed. Our Los Angeles area patients are extremely satisfied with their results.
Cheek Implants or Cheek Augmentation
Unfortunately as we age, the shape of the Cheeks change, because the amount of soft tissue over the Cheek bone decreases and shifts downward toward the corner of the nose and mouth. With age, gravity pulls the facial tissues towards the nose, mouth and center of the neck giving the face a more angular and relatively more masculine look. As the Cheeks fall, the face has an overall gaunt and aged appearance. Hollowness appears under the eyes, dark circles appear or are accentuated, and the Cheek folds between the nose and mouth (nasolabial folds) are exaggerated. These changes begin to occur in the thirties. Cheek enhancement or cheek augmentation with an implant can correct these problems by elevating the soft tissues of the midface, thereby improving your overall appearance. Cheek implant surgery or cheek augmentation is typically completed in about an hour in our Beverly Hills surgery center.
A full rounded face is associated with youth and vitality. Hollow, sagging facial features can be associated with age, illness or even a sad or depressed emotional state. There are several ways to restore your face to its original youthful contours. A Cheek Lift or Midface Lift will elevate the face from the area of the mouth to the lower eyes. Cheek implants will also elevate the midface, but will additionally give a more rounded, defined look to your cheek bones. Dr. Aharonov is an expert at many Non Surgical Alternatives to facial rejuvenation. Facial fillers such as Restylane and Juvederm, or your own fat, can be injected into the cheek area to enhance fullness and lost volume. Facial fillers will disappear over time, some lasting up to a year. They are ideal if you want to try out your new look, before making the final decision about Cheek Implant surgery. During your consultation with Beverly Hills Plastic Surgeon Dr. Aharonov, he will evaluate your individual issues and the goals you wish to achieve. Each patient is given a treatment plan based on what is best to enhance their own facial features and degree of facial aging.
Cheek Implants come in a wide variety of shapes and sizes and can even be custom made. The cheek implants that Dr. Aharonov uses are a soft solid that have been safely in use for many years. These type of Cheek Implants can be removed at a later date if it becomes necessary.
Cheek Implant or Cheek Augmentation Surgery
Dr. Aharonov prefers to place Cheek Implants through the mouth. This approach gives an excellent cosmetic result, without a visible scar. A small incision is made inside the Cheek within the mouth just above the gums. The Cheek tissues are carefully elevated until the covering of the Cheek Bone is identified. A small area or pocket, consistent with the shape of the chosen Cheek Implant, is created. The Cheek Implant is then placed within this pocket of elevated tissue, and the facial tissues are closed with dissolvable sutures. This prevents the Cheek Implant from moving until the tissues are healed, and the Cheek Implant is secured in place. Initially, the cheeks, face or under eye area may be swollen or bruised, but this is highly variable from patient to patient. As the swelling subsides, the Cheek Implants will begin to look and feel more natural. Some degree of numbness is to be expected after Cheek Implant surgery, but this too will subside with time. All of Dr. Aharonov's Los Angeles area patients are happy with the results of their Cheek Implant Augmentation surgery.
Fat Injections:
Cheek augmentation can also be accomplished with fat injections (or with fillers). Depending on how your cheeks are, the main issue might be volume loss that is associated with aging. Augmenting your cheeks with your own fat is an easy permanent way to restore your cheeks to how they used to be. This gives you a cheek lift and can diminish the appearance of your laugh lines.
Fat is harvested from your thighs or abdomen and is specially treated to separate out the pure fat cells. This is then injected into areas of need in your face, which can include the cheeks, eyelids, jaw line, or forehead and temples. The fat injections help reverse one of the biggest contributors to aging-- volume loss in the face. Facial volume loss leads to sagging brows, extra drooping skin on your eyelids, flattened cheeks, and a poorly defined jaw line. Fat injections can help reverse all these issues. Dr. Aharonov will discuss with you all of your options in his Los Angeles area office to come up with the plan that is best and most customized for you.
Facelift Surgery
A Facelift procedure or Rhytidectomy is intended to address the effects of aging in a patient's lower face, neck and jowls. As we age, the factors of time and gravity result in a loss of facial muscle tone and skin elasticity. The cheeks begin to sag creating jowls and distorting the jaw line. Loose skin appears in the neck, often referred to as a double chin or “turkey neck.” Deep creases between the nose and mouth or below your lower eyelid may form. Facelift surgery can “set back the clock” by rejuvenating the face, improving the most visible signs of aging by removing excess fat and skin, tightening underlying muscles, and redraping the skin of your face and neck, thereby restoring your more youthful facial contours.
Beverly Hills Plastic Surgeon Dr. Aharonov favors the “deep plane” technique also referred to as a “SMAS Lift” or “Composite Lift”. Unlike procedures that simply address sagging skin, the deep plane facelift repositions the deeper underlying tissue called the “SMAS layer.” Pulling this layer taught allows the redraped skin to sit naturally in its new position. As both the skin and underlying tissue are lifted together, the tightly pulled windswept look that can accompany a facelift done improperly is avoided. It also alleviates tension on the incision lines which minimizes visible scarring, although the incisions are well hidden within the hairline behind the temples and in the natural contours of the face and ear. Fat may be sculpted or redistributed from the face, jowls and neck, and underlying tissue is repositioned. Skin is redraped over the uplifted contours and excess skin is trimmed away. Sutures or skin adhesives close the incisions. Dr. Aharonov uses the latest advances used by only a handful of surgeons which greatly minimize bruising and swelling, reduces the risk of hematoma (bleeding under the skin), and alleviates the need for drainage tubes. The overall effect is a more natural refreshed appearance than simply having tightened the skin.
During your consultation in his Beverly Hills office, Dr. Aharonov will evaluate your skin muscle, bone structure, and other specific conditions that may have contributed to your aging appearance, and then tailor the procedure to your individual needs for the best result. A Facelift, which primarily address the lower face and neck, is often combined with other facial cosmetic procedures such as a Brow Lift, Eyelid Lift surgery (Blepharoplasty), Cheek Lift (Midface Lift), Neck Lift or chin or neck liposuction in order to achieve your realistic goals. Additional procedures that may further enhance the outcome of a Facelift may include: Facial implants or soft tissue augmentation to recontour your facial structure, and resurfacing techniques (such as peels) to improve the tone and texture of facial skin. Wrinkle reduction by Botox or Dysport injection may be recommended prior to your facelift (to help underlying muscles fully relax before repositioning and tightening) or after your facelift surgery to help maintain results. Although a facelift will not change your basic appearance or stop the aging process, it will restore a younger version that will then continue to age naturally over time.
Preparing for a Cheek Lift or Midface Lift: Preoperative Information
All patients undergoing elective Beverly Hills plastic surgery procedures should be in good health. Generally, you will see your primary care doctor for a physical exam and routine lab work. This is done several weeks prior to your Cheek Lift or Midface Lift. Please inform Dr. Aharonov of any existing medical conditions, medications, previous surgical procedures, or the use of alcohol, tobacco or drugs. Plastic surgical procedures are best performed on patients that do not have any medical conditions that impair healing, and are nonsmokers.
It is very important to avoid taking aspirin and other non-steroidal anti-inflammatories such as Advil, Motrin or Aleve for one week prior to Cheek Lift or Midface Lift. These medications may cause abnormal bleeding during your cheek lift or an increase in bruising after your midface lift. A list of over the counter medications and supplements to avoid will be given to you during your preoperative consultation.
It is also essential that you disclose any medical conditions such as underactive or overactive thyroid, cardiovascular disease, high blood pressure, circulatory disorders, diabetes, blood clotting disorders, or a history of forming large scars also known as keloid scars.
It is also best to avoid alcohol and very salty foods for three days before Cheek Lift or Midface Lift to prevent your skin from retaining fluid and swelling. The night before your Midface Lift surgery, do not have anything to eat or drink after midnight in order to insure that you have an empty stomach prior to anesthesia. If needed, you may take your essential medications with a tiny sip of water in the early morning on the day of your Cheek Lift.
You should be in the most optimal nutritional state prior to surgery. An adequate diet with certain vitamin supplements such as Vitamin C is recommended. Dr. Aharonov can discuss nutritional supplements with you during your preop consult.
Anesthesia for a Midface Lift or Cheek Lift
Dr. Aharonov performs all of his surgeries in an AAAHC accredited outpatient surgery center in Beverly Hills. Board certified anesthesiologists, which are medical doctors, perform all of his cases. Dr. Aharonov prefers to have a physician caring for your anesthetic needs during surgery, as their experience minimizes the potential of unpleasant postoperative symptoms. For his surgical cases, Dr. Aharonov uses an extremely safe combination of iv sedation and local anesthetic, not general anesthesia. This technique provides superior operating conditions combined with maximal patient safety and comfort. In all likelihood, you will awaken with very little discomfort, nausea, or anesthetic side effects. In his Los Angeles area surgery center, all of the appropriate monitoring, medication and emergency equipment are available at all times. On the day of surgery, you will meet your anesthesiologist and can discuss any questions that you may have.
What to Expect After Endotine Midface Lift or Cheek Lift
After a Cheek Lift procedure in our Beverly Hills surgery center, there will be some swelling and bruising in the midface or cheek area, or even under the eyes or along the lower face. This can take several weeks to resolve, but individuals vary on their recovery time. Immediately post-op, you should use ice compresses to relieve the pain and swelling. You will be given a prescription for pain medicine and antibiotics, although most patients do not require much pain medicine after the first day or two. After one week, Dr. Aharonov will remove the sutures from your Cheek Lift in his Beverly Hills office.
You should avoid strenuous activities for a week after surgery to decrease any swelling. Most patients return to work in 10 days to two weeks. Occasionally, some patients report that they can feel the endotines when they touch their cheek area. The endotines will gradually disappear, and will not be noticeable after awhile.
Our Los Angeles area patients are extremely satisfied with the results of their cheek or midface lift. They have a more youthful appearance, without an unnatural pulled look.
Surgical Considerations for Endotine Cheek Lift or Midface Lift
Procedures:
Cheek Lift or Midface Lift Preoperative Considerations
Anesthesia for Cheek Lift or Midface Lift
Postoperative Considerations for Midface or Cheek Lifts