Can cheekbone surgery and hollow cheek correction be done together?

Hello, I’m Director Jo Hyun-woo of Interface Plastic Surgery.

Among people planning cheekbone surgery, many want to improve a face that looks uneven from the front.

This is the kind of appearance I mean. The cheekbones are protruding, while the area below the cheekbones is sunken, and they want to smoothly correct the overall uneven contour.

Depending on the patient, cheekbone surgery alone can correct the uneven line well, but for people with naturally pronounced hollow cheeks, cheekbone surgery may make the hollowness look even worse.

Case where hollow cheeks remain after cheekbone surgery

Case where hollow cheeks appear more severe after cheekbone surgery

In this way, there are cases where the cheekbones are reduced after surgery, but the hollow cheeks remain the same or even look more severe.

For these patients, before surgery, we can perform a simple test to check how strongly the ligaments are pulling.

If you push the skin downward from the cheekbone area, there are some people whose tissue is being held very firmly.

In such cases, the ligaments are strongly attached to the bone, and if the bone is moved inward, the hollow cheeks may appear even more pronounced.

There are no true ligaments in the face that stabilize joints, but there are connective tissues similar to ligaments called facial retaining ligaments.

These connective tissues serve to fix and support the skin and deeper structures.

To give a few examples:

• Zygomatic ligament: originates from the cheekbone and supports the skin.

• Orbital retaining ligaments: support the area around the eyes and stabilize structures around the orbit.

• Mandibular ligament: connective tissue that supports the skin in the lower jaw area.

These three ligaments are the ones that most strongly support the face.

The ligament related to hollow cheeks is the zygomatic ligament.

You can think of these ligaments as preventing the skin from sagging downward.

If these ligaments are actually cut, of course the hollowing would disappear, but the facial skin would sag.

When performing facelift surgery, these ligaments are cut and pulled upward, but if it is not a lifting procedure, removing these ligaments completely may cause skin sagging.

Therefore, in my case, when performing cheekbone surgery, if I think the hollowness may become more severe, or if the hollowness looks more pronounced when pushing the cheekbone inward during surgery, I sometimes perform a procedure to slightly loosen the cheek ligament at the same time.

Rather than cutting the ligament completely, this means loosening the tension that is pulling it.

In actual postoperative cases, I was able to observe improvement in the hollowness.

Case 1 of tunneling the hollow cheek area during cheekbone surgery

Case 2 of tunneling the hollow cheek area during cheekbone surgery

Case 3 of tunneling the hollow cheek area during cheekbone surgery

As you can see from the patients’ photos, when a procedure to loosen the ligaments is performed together during cheekbone surgery, the hollow cheeks can be seen to improve significantly after surgery.

However, for patients whose hollowness became worse because this procedure was not done during cheekbone surgery, hollow cheek correction surgery is performed.

Hollow cheek correction is generally performed through a small needle puncture.

For people whose ligaments are pulling very strongly, like the last patient in the link above, correction with a non-incisional method is often difficult.

In such cases, I sometimes correct the hollow cheeks with an incisional method, making an incision of about 5 mm behind the sideburn area to loosen the ligaments more decisively.

When correction is performed this way, the ligaments can be loosened more smoothly than with a non-incisional method, so the corrective effect is better.

Let me show you a case.

Case 1 of hollow cheek correction using the incisional method

Case 2 of hollow cheek correction using the incisional method

If performed this way, it is possible to improve areas that have limitations with the non-incisional method.

However, there is a downside: because relatively thick blood vessels are located in this area, bleeding can occur, and there may be significant bruising.

This is because the procedure is done through a small incision and the field of view is limited.

If the surgery is performed carefully to minimize bleeding, better results may be achieved.

Today, I discussed several updated methods for correcting hollow cheeks.

The amount and method of correction can vary for each patient, so I recommend definitely having a consultation and choosing the surgery that suits you best in order to achieve a highly satisfying result.

Thank you.