Sagging cheeks after Lefort 1

[screwsandplates]

I had double jaw surgery and a genioplasty last January, and love how it looks in profile. I don't regret doing it, but...

The only problem is my cheeks. My malar fat pads to be exact. They sag and look/feel very puffy, kind of like this (not quite as severe)

I'm guessing it is from having bone removed and nothing to support it.  I'm only 21 years old but I look like I'm in my mid 30's D:

Should I talk to my surgeon about it? Last time I saw him and expressed my concern, he said that it was merely swelling. I don't think it is swelling anymore, as it has been a very long time since my operation, the puffiness is soft, and it looks amazing when I lie on my back (which would indicate sagging tissue). What are my surgical options? Has this happened to anybody else?

I'm trying to explain my concerns to my mom, and she says that filler will fix it. I don't see the point of adding volume to an already puffy face. I would rather lift the volume back to where it belongs.

Rant over.

[PloskoPlus]

Strange... My lf1 picked up all the loose skin around my mouth, nasal base.  8 months post op.

[girl]

Why do these doctors blame "volume loss" for everything.

The woman has too much volume in her mid face, which has dropped... hence the "hound" look.

[screwsandplates]

ragirl: I agree.

My surgeon impacted my upper jaw, moved it forward, and performed a counter clockwise rotation. The lower jaw and chin were also advanced.
I thought it was just a regular le fort 1, but maybe it wasn't because there is a screw just by my nose/inner eye socket.

[jaws]

I see this sometimes so it's not rare by any means. There's a good example in Reyneke's book about this and the picture of this girl is somewhere on the internets but I couldn't find it now. Clearly it has something to do with the midfacial bone structure but unfortunately I don't know any better.

EDIT: I found that picture. It wasn't as accentuated as I remembered. Page 330.

http://www.slideshare.net/kptaiping/aob-correct-by-le-fort-i-or-bsso

[Lazlo]

screwsandpllates, i think it's a combo of things.

do you have a negative under eye vector? That is, like the girl on p. 330 that Jaws posted you can see that the under eye area is not supported by a strong orbital rim or cheekbone. This can lead, even in young people, to mid-face ptosis: drooping fat pad. I think it also has to do with your tissue quality, some people's skin is more taut and elastic, other's thicker and prone to drooping. You have a few options none of which alone will necessarily fix it. 1) a midface lift, if you're a girl that's good because if they do a full face lift you don't have the sideburn behind the ear problem and facelift's by good surgeons are virtually undetectable when healed. 2) you may still need under eye support to fill that area in, so then either a cheekbone advancement (however you want to call that, modified lefort 3, ZSO whatever)

Of course the latter alone may suffice. Without pics it's tough to advise of course.

[screwsandplates]

Thanks, jaws, for that link. Lazlo, I can send you a photo privately if you'd like to give your opinion on it.

I don't have very prominent cheekbones or orbital rims. I'm sort of afraid to get a face lift for fear of it looking fake or limiting my future options, but if that's what I need then so be it. I would like to get whatever I needed done over the summer because I am so sick of surgery and I want to be done with it.

One last question: Should I bring it up with my jaw surgeon?

[PloskoPlus]

Thanks, jaws, for that link. Lazlo, I can send you a photo privately if you'd like to give your opinion on it.

I don't have very prominent cheekbones or orbital rims. I'm sort of afraid to get a face lift for fear of it looking fake or limiting my future options, but if that's what I need then so be it. I would like to get whatever I needed done over the summer because I am so sick of surgery and I want to be done with it.

One last question: Should I bring it up with my jaw surgeon?

Don't get a face lift until you're at least 40.  Most PS looks like crap.

[screwsandplates]

Yeah, I'm wary of facelifts.

[overbiter]

I had this problem but it went away after I got a genio. Ask for a genioplasty and get the surgeon to lower your chin a couple of mm. It will counter the impaction.

[screwsandplates]

That is a good suggestion, but I had a genio during my surgery :/ I'm not sure how to fix this sagging. It's become so awful that I don't even want to go out anymore. I can look ok in photos from certain angles, but in person, I look so old. If anyone else has encountered this problem, let me know.

[overbiter]

That is a good suggestion, but I had a genio during my surgery :/ I'm not sure how to fix this sagging. It's become so awful that I don't even want to go out anymore. I can look ok in photos from certain angles, but in person, I look so old. If anyone else has encountered this problem, let me know.

But did you have your chin lowered when the genio was performed? I had my upper jaw impacted which created sagging. Then when I had the genio I asked them to lower my chin. So my facial height is now probably about the same as it was before, and the sagging isn't really a problem now. I seriously think you should look into getting your chin lowered if you have this problem.

[screwsandplates]

I think my chin was minimally lowered. I already have a very long face unfortunately

[PloskoPlus]

I think my chin was minimally lowered. I already have a very long face unfortunately

Maybe zygomatic osteotomy to pick up the slack?

[screwsandplates]

I've booked a consult for radiesse to the upper cheekbone I hope it works out.