The midface comprises the lower eyelids, the jowls and the cheek bones. With age, the face loses its fullness and becomes flatter in appearance; the loose skin sags and unsightly tear sacs form under the eyes. The oval shape of the youthful face becomes first round, then angular, and a deep line appears between eyelid and cheek that is responsible for a tired and exhausted appearance. Hanging jowls draw another line from the nostrils to the corner of the mouth.
The goal of the midface lift is to counter the effects of age and gravity, and to replenish the loss in tissue volume. The techniques used for this purpose are blepharoplasty (blepharoplasty), endoscopic midface lift, silhouette lift, fat injections and dermal fillers.
Frequently asked questions about midface lift:
Who is a good candidate for this procedure?
Persons of middle age (35-50 years of age) whose midface has become flatter, who suffer from hanging jowls, large tear sacs, deformed tear troughs and deep lines between nostrils and mouth.
How is the midface lift performed?
Tightening and padding are usually combined. The following individual methods are applied:
- Fat injections are used to repair deformed tear troughs, pad the jowls and enhance the cheek bones. The face is restored to its youthful oval shape and the deep lines between nostrils and mouth are smoothed. The stem cells in the body fat used in this procedure support collagen synthesis in the skin; it becomes tighter and more lustrous. Fat injections alone may be sufficient for younger patients. They are also a good contouring alternative for younger people with a flat midface.
- of the lower eyelids pursues the goal of improving the tear sacs, padding the tear trough and correcting the transition area between lower lid and cheek. This procedure is frequently combined with a midface lift and fat injections.
- The midface lift is performed endoscopically through a small incision in the lower lid which is made during lid correction. Alternatively, an incision is made in the scalp. If the endoscopic procedure is performed through the lid, the skin is lifted either below or above the periosteum, the skin layer that covers the bone.
For the endoscopic midface lift, a mini camera is inserted under the skin and used to guide the surgical instruments. A midface lift is often combined with an endoscopic forehead lift. Access is also possible through an incision in the mouth. The method is very effective and leaves almost no visible scars. Some patients are, however, concerned about the long-lasting swelling associated with this procedure.
- Silhouette lift: Non-absorbable polymer strands are inserted under the skin and fixed just above the hair line. The strands carry tiny absorbable cones that act as anchors for the skin tissue. This technique is simpler and far less invasive than a surgical face lift. It is particularly suitable for middle-aged persons whose skin shows the first signs of sagging. Local anaesthesia is sufficient for this procedure, it is easy to apply and the recovery period is short. If no swelling or bruising occurs, patients can return to their normal lives the next day.
What to do and what not to do before treatment?
Three weeks before an invasive / surgical treatment patient must stop smoking and taking aspirin. In the last week, patients must stop taking any anticoagulant (“blood-thinning”) medicine.
The following substances are also prohibited:
- pain killers such as Apranax, Voltaren and Vermidon (alternative brand names are Minoset and Novalgin)
- multivitamin tablets containing ginseng, ginkgo biloba and coenzyme Q,
- green tea, herbal products containing linseed, sour cherry stalks, tomato seeds
- all diet products.
Does the procedure require anaesthesia?
Fat injections, blepharoplasty and endoscopic midface lift are performed in a clinic under general anaesthesia or under strong sedation. A silhouette lift can be performed in the surgeon’s office under local anaesthesia.
How long does the procedure take?
Fat injections take 30 minutes, a silhouette lift 30 minutes, lower lid tightening and endoscopic midface lift 1-1.5 hours.
Is the procedure painful?
Fat injections and silhouette lift are not painful. The endoscopic midface lift may be accompanied by pain and a feeling of tightness which are easily controlled with pain medication. Lid tightening is also painless.
What happens after the operation?
A silhouette lift can be performed in the surgeon’s office and patients are discharged immediately after the procedure. Swelling and bruising is not expected. After fat injections, lid and midface lifts, patients can eat 3 hours later, and are usually discharged after 6 hours. The next day the patient can take a bath. Sutures are removed after 5 days. Fat injections, lid and midface lifts cause long-lasting swelling and bruising; after endoscopic surgery the effect can last up to 3 months. Like with all other face operations, patients are strongly advised to avoid direct exposure to sunlight for the next 3 months.
What problems can occur after the operation?
The endoscopic midface lift is an effective method with a lasting result. Patients are mainly concerned about the swelling which take a long time to dissolve. Asymmetries and lip paralysis are rare side effects. Unnatural appearance or disappointingly small changes or no changes at all are also very rare. Paralysis usually disappears after 2-3 weeks. Lower lid surgery can be associated with eye oedemas and lid deformation; the healing process may also be slow. However, these problems pass with time or can be corrected with additional interventions. Fat injections may cause swelling and bruising. Dermal fillers in the nose-mouth-line may lose some of their volume.
Are the results of the midface lift permanent?
The endoscopic lift is permanent but it does not stop the ageing process. A return to the pre-operation state is impossible. Injections around the eyes and above the cheek bones are lasting; injections into the nose-mouth-line need to be replenished. The stem cells in the body fat used in this procedure supports the collagen synthesis in the skin; it becomes tighter and more lustrous. A silhouette lift lasts a few years and the strands can be retightened.