What is the Best Procedure to Lift the Midface?

Dear July4-

 

Your knowledge about mid facelift surgical options is impressive.  Endotine mid facelifts seem not to last as long as we initially thought, so more plastic surgeons are looking at a straight forward blepharoplasty, with possible fat grafting to the cheek areas.  

 

A "deep plane" facelift is an option, but increasingly, most plastic surgeons are doing "less" surgery, not more, in the area of the cheek.

 

Pulling on the cheek SMAS, the scaffolding or holding structure of the facial tissues, may help to lift up your mid face, assuming it was not done with your original facelift.  There are several options regarding this-  including tightening the SMAS, cutting the SMAS and then tightening it, or imbricating the SMAS.

 

So, seek out several opinions, but rest assured that your best result for your face should be possible with a plan that is individualized for your face.

 

Best Wishes,

Roy Kim, MD

   There are some people who can benefit from a traditional midface lift.  However, fat resuspension or restoration can be performed through any number of techniques without the risks associated with the more conventionally defined midface lift.  Find the plastic surgeon with ELITE credentials who performs hundreds of facelift procedures each year.  Kenneth Hughes, MD Los Angeles, CA

In my opinion the volume in the midface needs to be augmented  rather than pulled. Commercially available fillers and a patients own fat can be excellent choices. This can be compbined with lower eylid fat repositioning when appropriate to complete the result. In most case and intergrated approach works best. See a surgeon who has all the tools to give you the best results possible

A set of photos would really help to provide you with the best advice. In general, the results of a full facelift can last up to ten years before any touch ups are necessary, and it is the most effective procedure.  A full facelift addresses the following areas:
1) neck 2) Jowls and 3) Midface. Each patient has different circumstances, and a thorough in-person evaluation will help determine the best procedure for you.

Depending on your needs and goals, a less invasive procedure may be adequate.  An example is a mini facelift, where the incision is shorter. A mini facelift has its benefits as well, such as less time in the operating room and a lower cost.

In listening to your concerns, I would also advise you to look into replacing the lost volume in your midface with fillers, fat transfer, etc.  Lifting sagging tissue without replacing lost volume can lead to an unnatural look.

I would recommend seeking the advice of a specialist who has a great deal of experience performing facelift surgery.  I hope this helps!

 

Midface lift vs. fat transfer depends on what one finds on examination. It sounds like you would best be served by a cheek lift with an Endotine to accomplish what you said. The Endotine will fix the tissue to the bone and gives excellent results over the long term.

Midface surgery and midface concepts are relatively recent additions to the practice of cosmetic oculofacial plastic surgery.  As a pioneer of some these methods, generally mid face methods are great for medically necessary reconstructive surgery but not so great for primary cosmetic purposes.  For the most part, hyaluronic acid fillers for the mid face are a much safer, more predictable way of improving mid face ptosis.  There is no such thing as mid face cookie cutter surgery.  Each mid face deserves very careful evaluation in a personal consultation to determine which approach is right.

Everyone's situation and goals are a little different, so we need to have a range of options available. Often the issue in the midface relates more to volume than lifting, so procedures like fat grafting can accomplish a lot with a minimally invasive approach.

As the originator of the SOOF lift blepharoplasty I can tell you that in my opinion this is the best procedure for improving the hollow look under the eyes that accompanies the aging process. I've been doing nothing but this procedure since I originally published this approach around 1999 in the Archives of Facial Plastic. As far as improving the nasolabial fold a SOOF lift by itself will help minimally. Most of my patients that have midface laxity have laxity elsewhere and have a deep plane minituck or facelift. I would recommend you avoid endotine lifts in the midface and/or "thread lifts" as in my experience neither is very helpful in the long run. To lift the midface solely a malar pad lift is done in my office with good results. It can be done under local. Occasionally a cheek implant is also helpful depending on the patient and pertinent anatomy. Seek a facial specialist and get two to three opinions, look at the doctor’s photos and you'll do alright in most cases.

I personally do not like midface lifts. I think that the face loses a lot of volume when they age and it moves inward and downward. Traditional procedures tend to lift upward and inward which brings you to a point that is not like what you started with. Filling is better than face lifting in my opinion.

Typically, a combination of surgery and volume replacement is needed to address the mid face. An in person consultation would be needed to determine the optimal approach. Consult with 3 - 4 board certified plastic surgeons to explore your options.