The earliest signs of facial aging
often appear in the midface area, a triangle defined by
the inner and outer corners of the eye and the corner
of the mouth. There may be lax and wrinkled lower eyelid
skin. Fat bags become prominent, oftentimes casting shadows
beneath them. The line of demarcation between the lower
eyelid and the cheek (lid/cheek junction) begins to drift
lower, as time and gravity exert their effects. The entire
eye area appears to enlarge. In addition, the cheek drifts
downward and begins to bulge, thereby accentuating the
naso-labial fold. The net effect is that of "hills
and valleys," rather than a smooth and graceful cheek
Traditional plastic surgical procedures
have been ineffective in correcting all of the problems,
even in combined lower eyelid and facelift procedures. The
classic lower eyelid tuck could remove excess skin and fat
bags, but could do nothing with the lowered lid/cheek junction.
The result would often be smooth, taut skin without fat
bags but with a hollow-look to the eye. The traditional
facelift, or cheek and neck lift, has minimal effect on
the midfacial area, including the prominent naso-labial
In fact, traditional
plastic surgical procedures, intent on smoothing skin and
removing fat, frequently resulted in taut-skinned, gaunt
appearing faces. This, most certainly, was not rejuvenation.
During the late 1990's, there was
a sea of change in the philosophical approach of plastic
surgery towards treatment of facial aging. We realized that
youthful faces were full faces, and that fat itself was
not essentially bad. Fat itself was good, although it was
oftentimes in the wrong place. Emphasis was begun to preserve
fat where possible, to move it to advantageous places on
the face and to sculpt it to provide optimal results.
As a result of these changes in philosophy,
a new and sophisticated plastic surgical procedure - the
midface lift (or microlift)-emerged to address virtually
all the problems of the aging eye in one operation. It is
performed solely through an incision immediately below the
lashes of the lower eyelid and extends slightly down and
out at the outer corner of the eye, thereby mimicking a
crease line. Through this incision, the entire midfacial
triangle of tissue is gently separated from the bone, lifted
vertically, and secured to the bone at a higher level. Fat
bags may be trimmed if excessive, but most often the fat
is preserved and utilized to "fill in" the lid/cheek
junction line. Then, the excess skin is carefully trimmed
so that it is smooth. Many dissolving sutures are utilized
under the skin surface to produce and hold these changes
in place. The skin incision itself is closed with fine surface
sutures, which are generally removed within 4 - 6 days.
The result of a midface lift is a
smoother lower eyelid. Fat bags are removed. The lid-cheek
junction is both softened (or eliminated) and elevated,
thereby avoiding the "operated upon" hollow-eyed
look. Thicker tissues of the cheek are placed over the cheekbone,
resulting in an enhancement of the cheekbone with the patient's
own tissues. And the naso-labial fold is softened.
How would I look?
One may simulate the results of a
midface lift by looking in a mirror, placing a finger on
the cheekbone just below the outer corner of the eye and
very gently elevating the tissues 90% upward and 10% backward.
Note that the upper half of the naso-labial fold is improved.
The eyelid skin would be smoother and the fat bags would
be gone. It is important to understand that a lengthy naso-labial
fold, which extends beyond and below the corner of the mouth,
will not be totally improved with a midface lift alone.
Also, jowls will not be improved at all. These conditions
would require other procedures, oftentimes a facelift.
How is the operation performed?
A midface lift operation takes from
75 - 90 minutes and is performed on an outpatient basis
under sedation (twilight sleep) anesthesia, administered
by a board-certified anesthesiologist. There is no pain
or awareness during surgery and the eyes are closed throughout
the procedure. Afterwards, there may be soreness but no
pain. One is aware of feelings of swelling, pulling and
tightness - but there is no pain. There is usually a period
of swelling, which lasts 48 - 72 hours, after which the
swelling gradually diminishes. There may be bruising, which
usually disappears within one to two weeks. There will,
however, be continued healing under the skin surface, which
may last for three to four months. One should be capable
of returning to sedentary-type work - perhaps with some
camouflage makeup - within seven to ten days after surgery.
One may return to vigorous athletic activities within three
to four weeks.
What to expect
The results of a midface lift are
subtle. The object is to rejuvenate the midfacial area,
not to change your appearance. The goal is a refreshed,
rested, youthful look without a tell-tale "operated-upon"
look The midface will be full, graceful, and continuous,
without "hills and valleys."
While the midface lift
does not address all facial areas, when it is combined with
a modern two- or three-layer facelift, it adds a certain
smoothness to the area around the outer corner of the mouth
by providing a vertical lift with the midface and a lateral
lift with the facelift. The net result is that the corners
of the mouth and it's attendant accessory cheek lines, wrinkles
and jowls, are all improved to provide a very youthful appearance.
For those who have had
prior lower eyelid surgery prior cosmetic lower eyelid surgery
does not prelude a midface lift. Indeed, a midface lift
is often used as a reconstructive or rescue procedure to
improve the results of prior surgery, such as inadequate
removal of skin, over- or under-removal of fat, a low-placed
lid/cheek junction or prominent naso-labial lines. Obviously,
a decision for surgery is based upon very careful and individual
assessment of the problems presented.