References

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Cheeklifting Pearls

Clinton D. McCord, Jr.*

The lower eyelid should not be viewed as an isolated structure apart from the tissues beneath it, namely the mid-face, which can undergo significant ptosis. Lower blepharoplasty can be viewed as one part of midface rejuvenation and can be performed during a cheeklift. The cheeklift relates to the area between the nasolabial folds and the eyelid, namely:

•Eyelid fat

•Laxity and/or sagging of midface skin

•Ptosis of midface structures

Traditional facelifting techniques really address the neck and with a more oblique vector; in contrast, the cheeklift restores contour by operating in the vertical vector. The mid-face area can be approached subperiosteally through the lower lid. The two crucial steps to the cheek lift

are

•Controlling the shape of the lid by canthal fixation. Adjustments should be made according to if the eye is deep-set or prominent. With mild prominence, release of the lower retractors can help. With increasing prominence, a spacer graft is placed.

•Supporting the lower lid and cheek by anchoring the cheek flap/orbicularis. The orbicularis is doubly anchored: the base at the orbital rim near the lateral canthus and the tip at different areas of the deep temporal fascia. For nonprominent eyes, a more horizontal vector is used. For more prominent eyes, a more vertical vector is used.

Complications usually arise from problems in canthal fixation leading to eyelid fissure abnormalities, and sagging of the lid and cheek from problems in orbicularis anchoring. Further delineation of cheeklift complications can be categorized as follows:

•Primary fixation problem—correct with canthoplasty

•Primary skin shortage—correct with additional skin recruitment via secondary cheeklift

•Eye prominence—correct with spacer grafts

* Originally published in: Chen WPD. Khan JA, McCord, Jr, CD. Color Atlas of Cosmetic Oculofacial Sugery. Philadelphia: Butterworth Heinemann/ Elsevier. 2004.

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