Q. I had a face lift about 15 years ago and have been very happy. However, my cheeks are again beginning to sag, especially in the jowl area. I am 68 years old and do not think I want to go through another face lift. Is there an alternative to a full face lift to re-tighten my relaxed cheek skin?

A. Assuming that you are healthy, there may be a couple of options for you. If you have recurrent laxity of the skin in the cheek and jowl area, then probably the best choice for you is to undergo a cheek lift. A cheek lift is not as aggressive as a full face lift and the goals of a cheek lift are more limited. A cheek lift will tighten the jowls, re-establish a nicer jawline, and soften the nasolabial fold. The nasolabial fold is the crease between the corner of the nose and the corner of your mouth. The cheek lift will not significantly improve any skin laxity of the neck, if there is any present. The surgery to tighten the cheek can be performed under local anesthesia and a little Valium by mouth or heavier sedation if you so choose. The surgery takes about 2.5 hours and the downtime is about a week. There is very little pain after this limited surgery. On occasion, I will also recommend injecting a small amount of your own fat directly into your skin wrinkles around the mouth or cheeks. The fat comes from your abdominal area, and is harvested with a syringe and needle. Only about 1-2 teaspoons of fat are needed to fill in the wrinkles, and although there is never total resolution of the wrinkles, there is often nice improvement in the depth of the wrinkles. Complications from a cheek lift are minimal, but include bruising and swelling. There can be more serious complications but they are very rare. In my opinion, a cheek lift works nicely in refreshing a previously performed face lift.
Another alternative to a cheek lift is laser resurfacing of the skin. This procedure is more indicated if the main problem is wrinkles in the cheek and mouth area. The laser procedure can tighten the skin to some extent and soften the wrinkles, but it will not lift the skin if it is saggy. Laser resurfacing of the face can be performed under oral sedation, but for the faint of heart, deeper sedation is sometimes utilized. The main difference between laser resurfacing and a cheek lift is that the cheek lift elevates saggy skin and the laser will smooth wrinkled skin.