A New Kind of Face Lift

Beauty – March 10, 1996

Fortunately for those whose facial characteristics might be negatively exaggerated by a face lift, a new surgical procedure has been developed submalar augmentation (SA). During this procedure, the mid-face is filled and raised. The cheekbones become more defined because soft tissue isn’t stretched across them, and the lips remain full and well-formed.

“What really happens in the aging process is that we lose the soft, fatty tissue in the midsection of the face, below the cheekbones,” explains William J. Binder, M.D., a pioneer in submalar augmentation. “As both fat and tissue loss continue, hollows of the mid-face become more pronounced, until, in advanced age, the bone structure becomes distinct, giving the face a gaunt appearance. To compound the problem, without the ‘quilting’ provided by the inside tissue, the skin sags.” When the skin of the cheeks and mid-face is pulled unnaturally, which flattens and narrows the lips, the result can be a mask-like expression.

“People between their mid-thirties and their early fifties often come in to my office asking for a face lift or liposuction as a means of achieving a younger look,” explains Dr. Binder. “I’ve performed all these standards cosmetic procedures, but I was unsatisfied with the results of re-draping, stretching, peeling, sanding, suctioning. These procedures smoothed wrinkles, but they didn’t return the vibrant look of youth, or always fulfill the patient’s expectations.” Dr. Binder points out, “some procedures can even make the face look older. When the face loses tissue, suctioning just takes out more; check implants atop the cheekbone can distort the normal facial anatomy and stretch the already thin skin of the upper cheek.”

“If you put your fingers on your face, just under the cheekbones and press slightly with your fingertips, you’ll feel a natural depression. Loss of that muscle, bone and fat is what makes you look haggard and hollow-cheeked. A good example is Abraham Lincoln’s face. I use a specially shaped (wing-like) silicone implant to reverse that tired look. It props up mid-face skin and reduces the deep folds around the mouth.”

Submalar augmentation requires the use of a sophisticated implant that literally reshapes contours from within. Developed by Dr. Binder, with help from a NASA space engineer, the implants are three-dimensional, white, rubbery silicone, multi-angled and computer-designed to exacting specifications.

The SA operation, classified as a minor procedure, is performed on an out-patient basis in about 45 minutes. After indicating the outline of the implant on the outside of each cheek, the thin, shaped silicone is positioned through a small, half-inch incision in the fold between the upper lip and the teeth on each side of the face. The implant nestles within the existing concave mid-facial area to fill out eroded spaces or replace bony deficiencies. Few patients require any pain medication afterward, although a diet of soft foods is recommended. Minor swelling lasts only two or three weeks, and is generally much less than the aftermath of having a wisdom tooth pulled. “Submalar augmentation is probably the only restorative procedure we have in cosmetic surgery at present,” says Dr. Binder, who has presented his technique to the Academy of Facial Plastic Surgery in Washington, D.C., as well as at several other national and international meetings. Following 270 of his patients for a period of two to eight years, he reports that SA is his most successful facial procedure in terms of patient satisfaction, at about half the price of a face lift. For those who have had a face lift, or want to delay one, SA may be appropriate. A traditional face lift, which firms a jaw-neck droop, and SA, are not mutually exclusive.