15. Midface Lift

10.1055/b-0036-141963

15. Midface Lift

Garo Kassabian

15.1 Introduction

Early signs of aging typically appear around the eyes. The periorbital region is the area of the face we tend to focus on when interacting with each other socially. An individual may appear tired or sad without actually feeling the same. Some younger individuals may have these tired and sad expressions as an acquired trait. These patients are in general not contemplating facial rejuvenation procedures, because they are concerned about for looking different or having telltale signs of surgery.

The midface lift is ideal for patients experiencing signs of aging around the eye and cheek area. The primary benefit of this procedure is a more youthful eyelid–cheek interface because this procedure reduces the distance between the lower eyelid and the cheek. It also redirects the tear trough from a diagonal to a more youthful horizontal direction. The midface lift uses volumetric augmentation to elevate and shape malar tissue. The cheeks are lifted, not stretched, to achieve a fresher appearance. Secondary benefits are softer appearance of prominent nasolabial folds, lifting the corner of the mouth, and minimizing jowling. The lateral brow can be lifted within the same procedure to further contribute to a more youthful appearance.

The reason there is no visible scarring is that the small incisions are made inside the mouth and above the hairline. This is also why this procedure is referred to as a scarless facelift. It is also known as vertical lift, midface suspension, or subperiosteal malar suspension.

The midface lift is significantly less invasive than other procedures, resulting in a shorter recovery period, and it involves fewer risks. This procedure does not remove excess skin, but it can be combined with a blepharoplasty, facelift, or neck lift, tailored to each patient’s needs.

15.2 Indications

The primary indication for performing a midface lift is infraorbital hollow with tear-trough deformity and sagging cheeks. Secondary indications include the presence of prominent nasolabial folds and jowling.

I prefer the subperiosteal midface lift because this procedure elevates and shapes malar tissue, thereby attaining a volumetric augmentation. It also gives a more youthful eyelid–cheek interface by reducing the distance between eye and cheek. Indirect benefits are softening of the tear-trough deformity and the nasolabial fold. Despite entailing no visible scars, it is a powerful procedure that lasts on the average 10 years or longer.

It has a high patient acceptance rate because it is a simple, reliable, and quick procedure with minimal downtime. It is also a safe procedure with no lower eyelid complications.

15.3 Patient Selection

This procedure can be performed on young, middle-aged, and elderly patients.

In young patients, the focus is to improve under-eye changes, such as early tear-trough deformity and infraorbital hollow. It is also used to correct facial asymmetry (and facial lesions or moles). Here, a (Fig. 15.1) midface lift gives a lift and volumetric augmentation to the cheeks for improved aesthetics.

Fig. 15.1 Patient before and after Midface lift. **(a)** 27 yo patient before procedure presented with acquired facial asymmetry from an accident. She has not had prior surgery. **(b)** Same patient one year after Midface lift. (All surgical procedures performed by Garo Kassabian, MD, FACS. Photos courtesy of Lift md aesthetics, Beverly Hills.)

In the mid-30s (Fig. 15.2) to mid-40s (Fig. 15.3) patient population, in addition to tear-tough deformity and sagging cheeks(Fig. 15.4), the presence of prominent nasolabial folds and jowling is noticed. This group of patients benefits the most from a midface lift. This procedure offers a rejuvenated look without the telltale signs of a surgical procedure. ¹

Fig. 15.2 Patient before and after Midface lift. **(a)** 39 yo patient before procedure presented with infraorbital hollow with tear-trough deformity and sagging cheeks. **(b)** Same patient one year after Midface lift with upper and lower blepharoplasties and fat injection in tear trough area. (All surgical procedures performed by Garo Kassabian, MD, FACS. Photos courtesy of Lift md aesthetics, Beverly Hills.)

Fig. 15.3 Patient before and after Midface lift. **(a)** 43 yo patient before procedure presented with dark under eye circles due to hyperpigmentation, infraorbital hollow with tear-trough deformity and sagging cheeks. **(b)** Same patient one year after Midface lift with upper and lower blepharoplasties and fat injection in tear trough area. (All surgical procedures performed by Garo Kassabian, MD, FACS. Photos courtesy of Lift md aesthetics, Beverly Hills.)

Fig. 15.4 Patient before and after Midface lift. **(a)** 49 yo patient before procedure presented with dark under eye circles caused by cheek descent, infraorbital hollow with tear-trough deformity. **(b)** Same patient one year after Midface lift with upper and lower blepharoplasties and fat injection in tear trough area. (All surgical procedures performed by Garo Kassabian, MD, FACS. Photos courtesy of Lift md aesthetics, Beverly Hills.)

Older patients are also candidates for this procedure. In this patient population, the midface lift complements other procedures such as browlift, blepharoplasty, and facelift or neck lift. ²

Men are excellent candidates for the procedure(Fig. 15.5). During performance of a male midface lift, attention is paid to maintaining the masculine aesthetics ³ by focusing on the final three-dimensional shape of the cheek, which is less prominent than in a female patient.