Overview
The cheek between the eye and the corner of the lips is referred to as the midface. Sagging cheeks or lack of fullness is one of the first indicators of face aging. This is characterized by an increase in the distance between the lower eyelid and the cheek, a tear trough and malar trough, and a loss of the youthful curve of the cheek. Some jowls and nasolabial (nose-to-mouth) lines occur as well.
What is a Midface Lift?
The mid-facelift, also known as a cheek lift, is a minimally invasive surgery that uses one's own tissues to restore the natural convexity of the eyelid-cheek area and to remove excessive wrinkling or sagging skin.
The mid-face area is defined as the area of the face under the eyes, around the cheekbones, and down to the upper lip. A midface lift procedure involves restoring a person's cheekbones' position and prominence, as well as improving the continuity between the eyelid and cheek.
The objective is to realign the cheek's descending skin and fat with no visible scars. Furthermore, the cheek life process can soften the nasolabial fold, which is the tissue that connects the nostril to the cheek. As a consequence, the face seems more natural, young, and refreshed. A person's skin loses elasticity and tone as they age, leading the lower eyelids and cheeks to droop in the midface, giving a fatigued or drawn-out look. A lack of or diminished cheek structure can make one's face seem weary, worn, or haggard. Traditional facelifts, including the large nasolabial fold, typically have minimal effect on the midface region.
To improve your overall aesthetic result, cheek lift or mid-facelift procedures can be performed alone or in conjunction with other complementary cosmetic surgery procedures such as eyelid surgery, browlift, neck lift, or laser skin resurfacing.
A younger or middle-aged person with under-eye hollows or heaviness and drooping of the cheeks is a suitable candidate for a mid-facelift. A mid-facelift is not suggested for people who have loose skin in the neck area or who have more visible indications of aging that necessitate a more invasive facelift plastic surgery.
Anatomy and Physiology
Understanding the fascial planes is essential for safe and successful face surgery. Skin, subcutaneous fat, superficial muscular aponeurotic system (SMAS), parotid masseteric fascia, and parotid gland are the layers that go from superficial to deep in the lateral cheek. Beyond the anterior boundary of the parotid gland, the SMAS transforms into the mimetic muscles of the face, which include the zygomaticus, buccinator, risorius, and others. The SMAS becomes the temporoparietal fascia (TPF) above to the zygomatic arch, and the platysma inferiorly, overlaying the body of the mandible.
Because the facial nerve runs deep to the SMAS layer and its adjoining fasciae (TPF, mimetic muscles, and platysma), dissection on the superficial surface of this layer will aid in avoiding difficulties. The frontal branch of the facial nerve is approximated by a line that extends diagonally from 0.5 cm below the tragus to 1.5 cm above the lateral brow.
Similarly, the primary buccal branch that controls the zygomatic muscles can be reliably found at Zuker's point, which is located halfway between the root of the helix and the oral commissure. The transverse facial vessels, which are branches of the superficial temporal vessels, and the Stensen duct are frequently found in the same plane as this nerve branch, just inferior to it.
In the case of a mid-face lift, the goals are typically effacement of the nasolabial folds (NLFs) and restoration of youthful malar volume. The NLFs are generated by a near approach of the mimetic muscles to the dermis with no intervening fat, in a similar anatomic arrangement to the upper eyelid levator aponeurosis dermal attachments.
Because the malar fat pads are located superiorly to the perioral mimetic muscles' dermal attachments, as they descend, they reach those attachments and halt, resulting in NLFs. Because of this occurrence, as well as the aging-related facial fat loss, morphological rejuvenation of the mid-face may be more efficiently performed by repositioning and restoring volume to the malar fat pads than directly filling the NLFs with hyaluronic acid or calcium hydroxyapatite. Superior to the malar fat pads are the medial and lateral sub-orbicularis oculi fat pads, which contribute to the tear trough deformity seen in the aging face when separated from a descending malar fat pad.
The identification and division of subdermal retaining ligaments, particularly the zygomatic retaining ligaments, also known as the McGregor patch, and the mandibular retaining ligaments, which form the pre-jowl sulcus overlying the medial mandibular body as the buccal fat pad descends with age, is frequently required for restoring fat compartments to their youthful positions.
Why Undergo a Midface Lift?
The tissues above the cheekbones and below the eyelids tend to droop and lose volume with age and the impact of gravity. This causes the cheekbones to seem flatter, the lower eyelids to appear hollower, and the nasolabial folds to appear deeper. Importantly, midface descent generates a disjunction between the cheek and the lower lid. All of this leads to an older, fatigued appearance.
As a result, the midface lift is a treatment that tackles these alterations, making it a popular surgical operation for patients who want to address the indications of aging.
Traditional facelift surgery focuses on the lower half of the face and is frequently ineffective in addressing the lower eyelid and upper cheek areas. As a result, the midface lift can help elevate the fat pad in the cheek (known as the malar fat pad), giving the patient more fullness in the eye and cheek areas, giving them a younger, fresher, and more rejuvenated appearance.
Furthermore, midface lift surgery can be utilized to treat extreme lower eyelid retraction after a previous unsuccessful blepharoplasty surgery, or if the patient suffers trauma or facial nerve palsy. In these cases, a midface lift can improve facial symmetry.
A midface lift will not relieve crow's feet or fine lines and wrinkles in the midface area, nor will it treat all issues in the lower eyelids. If any of these are your primary concerns, another procedure, such as BoNT injections or laser resurfacing, might be more beneficial.
How do I prepare for midface lift surgery?
The surgeon will review your reasons for wanting to undertake the treatment, as well as your medical history and appropriateness for the surgery, during an initial appointment. You will also be questioned about any current drugs you are taking, any allergies you may have, your smoking habits, and any past procedures.
Once it is determined that you are a candidate for a midface lift, the surgeon will explain what you need to do to prepare. For example, if you are using aspirin or other nonsteroidal anti-inflammatory medicines, such as Ibuprofen or Voltarol, you will be told to stop for a short time before the operation since they might increase the chance of bleeding.
You will also be asked to stop smoking for a specified period before undergoing the procedure.
How is a Midface Lift Procedure Performed?
The midface lift treatment can be done in a variety of methods, using various incisions. The key for all approaches, however, is to mobilize the midface tissues and malar fat pad. A number of retaining ligaments are released. After the cheek tissues have been released, they are resuspended and elevated to rest higher and more securely on the facial bone and eye socket. Sutures are then used to close the wound.
Depending on the patient and the degree of the procedure, the surgery should take between 1-2 hours. It is usually done under general anesthesia, which means the patient will not feel any discomfort.
Midface lift can be performed alone or in conjunction with other forms of rejuvenation procedures such as brow lift or blepharoplasty.
It can also be done as a "blepharoplasty plus" procedure to improve the results of blepharoplasty surgery by combining the contours of the eyelid and cheek. When combined with blepharoplasty, this is a highly effective procedure that is performed through the same incision around the eyelid.
Midface lifting is quite efficient in restoring youthful volume to the cheeks and bringing the lower eyelid into harmony with the rest of the facial. It might be a valuable tool in enhancing a lower eyelid blepharoplasty.
What is the Recovery Process Like for Midface Lifting?
Recovery time after a midface lift is typically 7-10 days, making it quicker than recovery time after a standard facelift. Following the treatment, it is advised to rest for a week before returning to normal activities.
It is usual to have bruising, swelling, and inflammation following a midface lift treatment, but this should go away after a few days. Patients should apply ice packs to the affected areas for the first 48 hours to help the swelling go down. Although most people will experience only minor discomfort, you will be prescribed appropriate pain relief. Aspirin and Ibuprofen should be avoided because they can cause excessive bleeding or bruising.
Midface lifts have instant benefits; however, the cheek and eyelids are initially "overcorrected," making them seem overly high for the first 2-3 weeks. Do not be concerned; this will eventually settle into a more natural posture.
The surgery is usually done as a day case, which means that patients do not need to stay in the hospital overnight. Because the treatment is normally performed under general anesthesia, it is critical to arrange for someone to pick you up from the hospital afterward, as driving oneself home is unsafe.
Exercise and other heart-rate-raising activities can be resumed after two weeks. Patients are advised not to use make-up or styling products for the first week following surgery, since this might aggravate the healing regions. It is preferable to wash and dry the regions with gentle patting rather than rubbing.
Results
A mid-facelift can produce stunning effects, removing years off your appearance. Your face will have more pronounced cheekbones that are tight and free of sags. When the surgery is finished, you may notice that your cheeks are too defined, but they will gradually settle into a more natural posture over time. A mid-facelift is not designed to improve the lower face or neck, but there are alternative choices if that is what you want to improve.
What are the Side Effects, Risks?
Following the Midface lift, some swelling and minor bruising of the cheeks is to be expected. Swelling or bruising is uncommon. Infection after the Midface lift is uncommon; nonetheless, a brief course of antibiotics will be administered following the treatment. Numbness in the cheeks is typical and will go away after 4 to 6 weeks. Mild cheek tenderness is to be expected, and the implant can be felt until it reabsorbs after 10 to 12 weeks.
Facial nerve weakness is uncommon and usually resolves in 4 to 6 weeks. Scarring in the scalp is likely to be barely apparent, and infrequently, scar thickening may make this noticeable. Arnica tablets are recommended before and for two weeks after your Midface lift to aid healing and reduce bruising and swelling.
What is the average cost of a mid-facelift procedure?
A mid-facelift might cost anywhere between 4,000$ and 10,000$. The cost of a mid-facelift varies according to location, board-certified facial plastic surgeon, and length and complexity of the cosmetic surgery.
FAQs
1. How long does midface lift results last?
When compared to other anti-aging cosmetic treatments, such as injectable fillers, the effects of a midface lift are long-lasting and permanent. Patients often do not require "top-up" midface lifting treatments.
Most patients are overjoyed with the results of their midface lift treatment since it significantly improves their look, especially when paired with blepharoplasty. When done correctly, the results appear natural.
We recommend maintaining a healthy lifestyle and, if necessary, undergoing other non-surgical procedures as you age to maintain a younger appearance.
2. Is a midface lift different to a facelift?
Yes, these are two distinct operations. A midface lift addresses the middle of the face, from the eyelids to the cheekbones and up to the upper lip. A facelift, on the other hand, targets the bottom portion of the face (mouth, neck and jowls). Midface lift recovery is typically faster than facelift recovery.
3. Is a midface lift right for me?
Because this surgery is more intrusive than others, it is only appropriate for a certain type of patient. You may be a candidate for a midface lift if you meet the following criteria:
- You have heaviness below your cheeks (sagging)
- You have hollowness under your eyes
- The eye-cheek junction is detached
- You are unhappy with your current appearance and wish to look fresher and more rejuvenated
- You require corrective surgery following previous blepharoplasty, trauma or facial nerve palsy
- You understand the risks and are willing to follow the recommended pre and post-operative guidance
- You are in good health
4. Is midface lift surgery painful?
No, midface lifts are rarely uncomfortable. Patients will be sedated and will not experience any discomfort during the treatment. Patients will suffer some slight bruising and swelling after the operation, but this will go away fast. Over-the-counter pain relievers and following proper aftercare instructions will help to reduce any discomfort.
5. Will I have scars after midface lift?
Scars are well concealed beneath the natural crease of the lower eyelid lashes, so scarring should be minimal and undetectable.
Conclusion
The mid-face is the area of the face between the eyes, the cheeks, and the top of the mouth. The loss of facial fat causes signs of aging in this area. High midface curves with a short lower eyelid vertical height are characteristics of youth.