Full, high cheeks are among the most recognized signs of beauty and youth in our culture. Unfortunately, the aging process gradually reduces the fullness of the cheeks, and many procedures have been developed to reverse this trend. Collectively, these procedures are referred to as “midface lifts”.
The “midface” is the area from the lower eyelids down to the level of the mouth. By lifting the soft tissue in this region, the face regains a youthful, healthy appearance. If you feel that your cheeks are less prominent than in years past, or you are unhappy with the “smile lines” that are created by your cheeks, then a midface lift may be right for you.
Types of Midface Lifts
The most extensive midface lift techniques involve making two incisions on each side: one inside the mouth (at the bottom of the cheek) and another in the hair behind the temple. First, the soft tissue of the cheek is freed to allow it to move. Then, an absorbable fastening material is used to lift the soft tissue to a higher, more youthful position and secure it in the temple region. A less extensive, but still effective, method is to lift and secure the malar fat pad through an incision immediately below the lower eyelid. In this approach there is no need for an incision in the mouth.
Midfacial Anatomy
Several types of tissue contribute to the fullness of a young midface, including skin, muscle, fat, and bone. In particular, there is a prominent collection of fat below the cheeks called the “malar fat pad”, and as we age this pad becomes thinner and falls. Also, the high bones of the cheek become smaller over time. These changes, along with the thinning and sagging of aging skin, lead to a loss of soft tissue in the cheek region. Therefore, many midface lift procedures involve not just lifting, but also replacing, the soft tissue of the cheeks.
Suitable Patients for Midface Lift
Patients who benefit from midface lifting have two common complaints. First, they dislike the hollowing, flattening, or loss of cheek fullness that occurs with age. Second, they are unhappy with the prominent “smile lines” (also called “nasolabial folds”) that extend from the sides of the nose to the corners of the mouth. A midface lift can improve both of these features. Ideal patients should also be in good health, and should be able to avoid blood thinning medications around the time of the surgery.
The Consultation
When you arrive at our San Francisco plastic surgery office for a consultation, you will be asked to complete a detailed questionnaire about your medical and surgical history. Dr. Kabaker will then take standardized photographs, and examine the position and fullness of your midface. Most importantly, you will be given ample time to describe your complaints, and to learn about your proposed procedure and how it might help you. Our doctors will also use a state of the art computer photo alteration program to predict your surgical outcome.
As mentioned elsewhere in this website, we stress patient education. So, during the consultation, you will learn a great deal about the anatomic considerations that cause your complaints, how they will be changed, what you will experience during the recovery, and your risks and alternatives to treatment. You will be given much information in writing, and we are always available for a second consultation, if you wish to review anything.
The Pre-operative Process
For the two weeks prior to your procedure, you should refrain from using common medications that decrease your blood’s ability to clot, including aspirin, ibuprofen, Advil, Motrin, Bufferin, Naprosyn, and large doses of vitamin E. Our doctors will give you specific instructions based on your current medications. If you have any headaches or other pain, taking acetaminophen (Tylenol) is fine. You should also avoid smoking for two weeks before your surgery. The night before your surgery, you should eat a normal dinner but avoid all oral intake after midnight. This includes drinking anything, even water.
When you schedule your midface lift, you will be given a detailed set of instructions that includes much more information. A copy of these Midface Lift Instructions is available for you to review now.
Your Procedure
After you are properly anesthetized, small incisions will be made inside your upper lip and in the temple hair on each side. Alternatively, you may need only small incisions in each lower eyelid, under the lashes. Next, the soft tissue of the cheeks (usually the malar fat pads) will be grasped by absorbable sutures or thin absorbable plastic strips. The suture or strip will then be secured to the deep temple tissues, or strong tissue under the lower eyelids. The result will be an elevation of the cheeks to a more youthful and fuller position. Some patients are also helped by the injection of a small amount of fat into the cheeks, to replace soft tissue that has been lost with aging. This fat is often harvested from the abdomen.
You will need to arrive about two hours prior to the start of your procedure. The entire procedure will take approximately two hours, and you will stay in our recovery room about one hour while you recover from the anesthetic. When returning home, you will need a friend or family member to accompany you.
Anesthesia
Most midface lift patients receive a deep sedation, which means they are completely asleep during the procedure but are breathing on their own, so there is no need for a breathing tube. This type of anesthesia is always provided by a highly qualified doctor or nurse anesthetist, who will be dedicated to the anesthetic treatment for the entire case. Every patient will be completely comfortable and the procedure itself will be pain-free.
Midface Lift Recovery
The discomfort after a midface lift is usually very mild. You will be provided pain medication and other suggestions to minimize your soreness. Most patients report a sensation of heaviness and tightness in their cheek skin, which arises from swelling. Actual pain, though, is fairly rare. Usually there is no need for a dressing.
The sutures used for your skin incisions will be removed one week after surgery. You will have mild swelling and bruising of your face for one to two weeks. You should be able to return to light activities after your sutures are removed at one week, but heavy exertion and exercise should be avoided for up to three weeks. You should keep in mind that your cheeks may look too high or full immediately after surgery – this is a normal consequence of swelling, and will resolve.
FAQs about Midface Lift
If you have further questions about midface lifts, check the list below to find answers. While some information presented here is also contained in the above text, these short responses should complete your introduction to midface lifts. We also encourage you to consult with Dr. Kabaker for individualized answers to all of your questions.
Am I a good candidate for midface lifting?
The best midface lift patient is in good health, a non-smoker, and is able to avoid blood thinning medications for two weeks before surgery. He or she is unhappy with the loss of fullness in the cheek regions, and the presence of deep smile lines.
How does a midface lift differ from a facelift?
A midface lift is intended to treat the middle 1/3 of the face – the region between the lower eyelids and the level of the mouth. In contrast, a facelift improves the lower 1/3 of the face, from the corners of the mouth down to the jawline. In many patients, these two procedures are performed at the same surgery, for a more complete facial rejuvenation.
Are there other ways to improve my smile lines?
Aside from midface lift surgery, the best treatment for smile lines (or “nasolabial folds”) is the injection or implantation of a filler below them. Injectible fillers include collagen, hyaluronic acid (Restylane, Juvaderm), or hydroxylapatite (Radiesse). All of these products give an effective, but temporary, remedy for deep smile lines. Permanent solutions include the injection of fillers such as Artecoll or silicone, or the implantation of a solid filler like Alloderm or gelfoam. Remember that filling the nasolabial folds will not elevate or replace soft tissue in the cheek.
Are there injections that can improve my cheeks?
If injected correctly, several products can replace soft tissue in the cheeks. Temporary fillers such as collagen, Restylane, Juvaderm, or Radiesse are effective, but need to be re-injected every one to two years. But, these fillers only improve cheek fullness; they do not lift soft tissue that has fallen with time.
Do cheek implants create the same improvement as a midface lift?
Cheek implants are effective at replacing lost volume of the cheeks. They are permanent, but can be removed at any time if needed. They do not lift the cheeks, but they do create full cheeks with a similar appearance to that generated by a midface lift.Dr Kabaker hace cumplir los implantes de mejilla y, en ocasiones, un paciente tendrá mejilla implantes y un ascensor junto midface.
Are the results of a midface lift natural appearing?
With the correct amount of elevation, the results of a midface lift are very natural, and generate a young, healthy appearance. Immediately after surgery, the cheeks often look unnaturally high, but this resolves during the healing process.
Can I have other procedures done at the same time as a midface lift?
You can, and often patients decide to have other rejuvenating procedures done at the same surgery. These can include facelifting, eyelid lifting (blepharoplasty), brow lifting, and neck lifting. Doing multiple procedures on the same day does not lengthen the recovery time, and it allows the patient to accomplish many goals with one surgery.
How many doctors should I consult with?
As many as you need to feel completely comfortable with the doctor you choose. Some patients are able to settle on their surgeon after only one consultation, while others require several to best compare their rapport with each doctor.
Are “before and after” pictures helpful?
They are, and our doctors will show you many. However, the best prediction for the outcome will be determined during your consultation, as your doctor examines your face carefully.
Do you use computers to change my pre-operative photos?
Yes, we do, and we use the latest software available to provide realistic projections. Keep in mind that these “morphed” images are not guarantees of an actual result, but will help you as you plan your procedure.
Do I need to see my own doctor before a midface lift?
All patients require basic lab tests, and typically patients over the age of 45 require a written clearance from their personal physicians. All specific requirements are described in the attached Midface Lift Instructions .
What do I need to do the day before surgery?
The day before a midface lift, you should eat normally but avoid excessively heavy meals, or foods that can lead to acid reflux. Prepare your affairs so that you completely relax and rest after surgery. Most importantly, do not eat or drink anything after midnight before your procedure. See the attached Midface Lift Instructions for all suggestions.
Where does the surgery take place?
Procedures are done at the Aesthetic Facial Plastic Surgery Our Clinic, our fully accredited surgery center.
What kind of anesthetic will be used?
For almost all cases, a deep sedation will be used, which means you will be completely asleep and pain-free during the entire case. No breathing tube will be needed in these cases. Some other patients, having shorter procedures, can have lighter sedation. However, everyone will be completely comfortable during the procedure.
How long does the procedure take?
Midface lifts take about two hours to complete.
How much pain will I have after surgery?
Midface lifts do not generate excessive pain during recovery. You will mainly experience a sensation of tightness in your skin, which comes from swelling. Discomfort is well controlled with medications, which we will prescribe.
What are the risks of surgery?
Adverse events are rare. One possible but uncommon risk is infection, which can be easily treated with antibiotics. In fact, we prescribe antibiotics to all patients immediately after a midface lift if an oral incision is used. Another potential risk is slipping of the sutures used to secure the soft tissues. Although very rare, this condition is disconcerting and can be corrected with a brief surgical procedure. Other possible risks include bleeding and nerve damage. During your consultation with Dr. Kabaker, you will be able to discuss all risks and complications.
Will I have scars?
The scars of a midface lift are well hidden in the hair of the temple, or by a natural crease just below the lower eyelid lashes.
How much time off should I take from work and exercising?
You should plan to take one to two weeks off of work, so swelling and bruising can resolve. Exercise should be avoided for about three weeks after surgery.
Do patients ever need another midface lift?
A revision midface lift is rarely needed. Your face will always look younger and more refreshed after surgery, and even with continued aging your cheeks should maintain much of their fullness.