" If you look at facial rejuvenation over the last 20 years, one of the first things we established was rejuvenation of the neck by working with the submental fat pad and the SMAS (superficial musculoaponeurotic system),” recounts Dr Darryl Hodgkinson. “But no matter how you controlled the SMAS, you couldn’t do anything about the naso labial folds. Then the brow lift became popular, but still the area between the eyes and the mouth couldn’t be addressed.”

Soft tissues from the cheek start to fall down with age and create deeper naso labial folds, a flattening of the mid face and give a square appearance to the shape of the face. “Sometimes when you critically looked at the patient’s before and after photos after a facelift, yes they may look better but the midface is often still falling down.” explains Dr Hodgkinson.

By the early 90s facial implants were helping fill and lift the mid third of the face quite successfully, then when endoscopes were developed for cosmetic surgery purposes there became an opportunity of accessing this area and being able to lift it. “The problem has always been the technical difficulty of moving from the upper third of the face into the mid third – there are facial nerves between the two,” says Dr Hodgkinson. “The endoscope didn’t eliminate this technicality.”

However, what it did do is allow for smaller incisions to be made in the temporal area. “Now we use a procedure where we use an incision inside the mouth and identify the structures from inside the mouth and cheek,” explains Dr Hodgkinson. “Then sutures are directed up and suspended into the temporal region, accessed through small incisions hidden in the hairline.”

This gives the cheek area a lift deep underneath the skin. At the same time, a cheek implant can be placed if the patient wants more volume. “The surgery is similar for both because you free up the area just the same as if you are putting an implant in, but then you put sutures underneath to suspend the cheek up,” says Dr Hodgkinson. “No skin is removed and the tissues, over time, attach to the bone and are permanent and you don’t see or feel the sutures because they are at the bone level.”

“ There are very few risks with this technique. The main complication is that the suturing might break, but to minimise this it is held into place for 7-10 days with tape,” says Dr Hodgkinson. “There’s always a risk of partial damage to the facial nerves but this is rare and I’ve never seen permanent damage to a nerve.”