All About Cheeks and Cheek Lifting


Prèface Cosmetic prides itself in rejuvenation of this part of the face.


As we age, our cheeks tend to droop. This is called mid-face ptosis or cheek ptosis and is an inevitable consequence of ageing. The ‘high cheekbone’ is always aesthetically valued. However, even those of us blessed with ‘high cheekbones’ may find that with age they are not as high and prominent as they once were. In addition those marionette lines that become more prominent as we age are a direct result of mid-face and cheek droop.


At Prèface we have a variety of techniques to deal with cheekptosis:

  1. Mid-face lifting (cheek lifting) using Endotine anchors
  2. Mid-face lifting using ribbons
  3. Mid-face lifting using threads
  4. Lipofilling (fat transfer)

How does cheek contouring and lifting work?


Dr Hollenbach offers a number of techniques in trying to restore the normal cheek contour. Surgical techniques include mid-face lifting which can be divided into lifting straight up or what is called a vertical vector or elevating ‘up and out’ which is often called a superolateral vector, this is where the cheeks are lifted out towards the temple area rather than straight up.


Depending on your facial configuration, generally it is one technique or the other that will be more aesthetically pleasing. Both techniques use Endotine anchors, which are placed beneath the muscles of the cheek and then sutured in place.


Just as Endotine anchors are used in brow lifts and absorbed, these anchors too are absorbed over a period of time. The cheeks continue to be elevated over this period and beyond as there is collagen deposition and scarring in the deeper tissues, keeping the cheeks in the desired position.

What are the risks and recovery involved with cheek lifting surgery?

Like all surgical procedures, Cheek Lift surgery carries risks. It’s important to be aware of common risks so you are able to weigh up the benefits, risks and limitations of the surgery. Below is a list of possible complications and specific risks for Cheek Lift surgery. General risks and complications of surgery can be found here. There may be complications that are not listed here and some lifestyle factors and medical conditions can cause greater risks.


Risks of Cheek Lifting Surgery:

  • Hematoma
  • Scarring
  • Nerve injury or paralysis
  • Hair loss around scars
  • Skin loss
  • Bruising and swelling
  • Numbness around operated sites
  • Post-operative asymmetry

Are there less invasive options?

For those who would like a less invasive procedure, threadlifting can be an appropriate technique in the cheeks, using a combination of both anchoring and free-floating Aptos PCL threads. This can be an effective technique in younger patients, however it often does not have great longevity in older patients.


For these older patients cross-linking thread techniques are combined with other treatments such as lipofilling, where a foundation of collagen is encouraged in the cheek area to form a collagen platform. In time, usually 6-12 months, this area can be lifted as a unit using more traditional threadlifting techniques. This then becomes a two-stage procedure.

Adjunctive procedures for cheek lifting.

Mid-face or cheek lifting can be combined with lipofilling, using fat from the abdomen, which is described in great detail on our lipofilling page on this website. Lipofilling can also be performed as a standalone procedure.

What are cheek implants?

Whilst Dr Hollenbach has performed cheek implants in the past, these are not his preferred option as he feels that a more natural cheek appearance can be achieved using mid-face lifting. Cheek implants can often produce an overdone appearance, or even worse, can migrate with time and look completely unnatural.

Our philosophy regarding other techniques.

In the cosmetic industry, dermal filling has become the mainstay treatment of the cheek area. Dr Hollenbach strongly discourages this as there are many side effects associated with dermal filling, as well as the appearance of being overdone which is all too familiar to us now.


Artificial dermal fillers tend to migrate over time and even though they are marketed as short acting, there is evidence in MRI scanning that they can persist in the injected areas for many years. It is for this reason Dr Hollenbach stopped doing this procedure some years ago and encourages the use of a more organic and natural ways to treat this area such as using lipofilling techniques.


There is no one treatment that is best for everybody in this area. Dr Hollenbach will be happy to discuss which treatment might be best for you and will indicate which option he feels is best for your particular circumstance, understanding your aesthetic desires.

To find out more about cheek lifts click here

Marionette lines


Often cosmetic clinics will advise to administer dermal fillers into this part of the face or even use anti-wrinkle injections. The true cause of marionette lines however is due to Cheek Ptosis and one only has to manually push up the cheeks to see what happens to these marionette lines. Generally, they magically disappear with elevation.


In other words, mid-face lifting, cheek lifting, thread cheek lifting, or lipofilling the cheek will generally improve marionette lines.


It has been a long time since Dr Hollenbach has sought to improve the appearance of these lines by doing anything to the lines themselves. Co2 laser over the entire face will also soften these lines, however, if not performed with some sort of mid face or cheek procedure, the results are disappointing.

Discover whether cheek lifts are right for you.
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