The midface is an essential component of an attractive face. With aging process, fat tissue that normally drapes over the cheekbones begin to droop with gravity. Due to the laxity of the skin and lack of subcutaneous supports of the midface, the fat of the lower eyelid and upper cheek begins to droop. The result is less prominent cheek volume, hollowness under the eye (tear trough area), redundant skin and excess fat at lower eyelids and prominent folds between the cheek and nose (nasolabial fold). Sagging cheek fat can also alter the appearance of the lower cheek. In addition to these changes, there is also volume loss from the cheek with aging resulting in loss of cheek fat and muscle.
Midface lift (cheek lift) is a cosmetic surgical procedure that is performed either alone or in combination with other procedures to rejuvenate the areas around the cheek and lower eyelids. The goal is to reposition the sagging fat of the cheek over the cheekbone and to restore the cheek volume. The droopy cheek tissue can be lifted up over the cheekbone restoring the more prominent youthful contour, improving the lower eyelid-cheek junction including tear trough area and softening the undesirable cheek fold.
Depending upon severity of the condition, midface lift can be performed in several ways, including endoscopically via incisions hidden behind the hairline in the scalp, directly through a standard facelift incision (in front of the ear), directly through a lower eyelid incision or fat grafting to restore and augment the cheek volume. Often midface lift can also be combined with additional cosmetic surgical procedures such as upper eyelid blepharoplasty or browlift to order to achieve desirable aesthetic outcome. Thus, the outcome of midface lift alone or in combination with additional procedures help to transform into a more youthful and fuller appearance, reduction of tear trough deformity and excess skin under the eyes, and softening of the nasolabial folds.
IDEAL CANDIDATES
The midface lift is often appropriate for patients who are generally looking to improve droopiness and puffiness in the cheeks or beneath the eyes or hollowing in the cheeks. For those who are not yet ready for a full facelift, this is an excellent, less invasive option which can provide a very natural, often subtle result. Patients should also be in good general health and have realistic expectations for improvement. It’s important to understand that the midface lift is not a replacement for a full facelift. Some candidates may be better candidates for a traditional full facelift if they are looking to address significant excess or sagging skin on the outer face, neck and jawline.
PRE-OPERATIVE EVALUATIONS
Communication is vital in order to achieve the patient’s goals. During the initial consultation, patients will have the opportunity to discuss their goals and desirable results with the plastic surgeon. The plastic surgeon will work closely with the patients to reach an agreement about the expectations from the surgical procedures involved and their long term benefits. Every patient is different, therefore a specific treatment regimen is planned to suit an individual’s need.
The preoperative assessment for midface lift may involve:
- Discussion about patients’ expectations and desired outcome
- Medical conditions, drug allergies and previous medical or surgical treatment
- Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
- Examination of the face and its soft tissues
- Discuss the options available for midface lift and other facial rejuvenation procedures
- Preoperative evaluation for types of anaesthesia
- Photography for preoperative and postoperative evaluation
PREPARATION
- Preoperative medical evaluation including blood investigations
- Avoid certain medications or adjust your current medications
- Stop smoking or alcohol for about 2-3 weeks prior to the scheduled surgery
- Avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding and bruises
RISKS AND SAFETY
It is important for patients to understand that every surgical procedure has its own complications and down time. However, if a patient is assessed properly before the surgery and postoperative care is given adequately, these risks can be eliminated or reduced. The risks involved in facelift surgery may vary depending upon the nature of the surgical procedure.
Some of the risks of midface lift include:
- Wound infection
- Poor wound healing (higher risks in chronic smokers)
- Unfavorable scarring
- Bleeding (hematoma)
- Anaesthesia risks
- Nerve injury resulting in cheek numbness or muscle weakness
- Facial asymmetry
- Fat necrosis
- Fluid accumulation
- Skin contour irregularities
- Skin discoloration, sensitivity or swelling
- Possibility of revision surgery
POST-OPERATIVE EXPECTATIONS
Bruising and swelling are common after midface lift, both in the midface area and around the eyes. They typically resolve within seven to ten days after the surgery. Discomfort can be managed with pain medication. The smile may appear unnatural at first due to over-correction of the cheek pad, but this settles into a more natural position gradually with time. The final results are usually seen after two to three months. Most patients feel well enough to return to work and other activities after about two weeks.
POST-OPERATIVE CARE
- Follow the postoperative instructions given carefully
- Head elevation especially when sleeping for 1-2 weeks
- Take the prescribed medications as instructed
- Compressive bandage or facial garment may be used for 3-5 days
- Ice compression on the cheek area for 3-5 days
- Regular wound cleaning with antiseptic solution and antibiotic ointment
- Avoid strenuous physical activities for 3-4 weeks
- Make up to cover the bruises and discoloration may be allowed from third day post surgery
- Regular use of sunblock for 3-6 months after the surgery
