I had a midface lift at the time of my eyelid surgery, and now my eyes look different. Will canthal surgery correct my problem?
The most critical issue here is to understand how your face has changed.
You are absolutely correct to say that your eyes have changed. However, your analysis of the problem is not correct. I suspect that very few surgeons you consult will understand the issues. At the same time I am equally certain that many surgeons would be more than happy to perform a lateral canthoplasty for you. They will mean well but they are simply going to make your situation worse, not better.
I completely agree that surgery has altered the shape of the eyes. This is the most obvious change. The outer corners of the eyes are higher after surgery compared to your preoperative status. There is also a subtle lower eyelid contour abnormality of the lower eyelids. It is true that a properly executed lateral canthoplasty has the potential to reposition the lateral canthal angle. In my many years of repairing prior eyelid surgery, I have found that very few surgeons are capable of actually achieving that type of result in a natural way. Not impossible, just very difficult as the surgery must be done with the patient at least awake enough to open and close the eyes to judge the effect of repositioning of the angle. If surgery is performed under general anesthesia, then in my opinion, the likelihood of success is very low.
Canthoplasty, and to a lessor degree, cathopexy, risk over shortening the lower eyelid. It is true that many surgeons will shorten the lower eyelid as part of the canthoplasty procedure. The procedure is taught this way and this maneuver is important for pathologically lax eyelids. However, over shortening an eyelid that does not need to be shortened will simply force the lower eyelid below the curvature of the eye. This will actually make the lower eyelid look more pulled down. The outcome will be disappointing.
So lets talk about the real issue. It is interesting how important the eyes are in interpersonal interaction. Subconsciously, we scan the face of the person we are speaking to. During conversation, we actually scan a triangle on the face that includes the eyes, the nose and to a lesser degree, the mouth. This is so profoundly ingrained, that one expects someone listening to you to look at you in this manner. We are not even be aware of this gaze pattern. However, we can be acutely aware when the pattern is altered in someway. What you would experience when you are speaking to someone is the sense that they are not really paying attention to you. When does this happen? Studies have shown that changes in the face will alter this scan pattern. There are some very nice studies of this in the head and neck literature in looking at scan patterns when viewing someone who has a facial lesion or just had surgery to remove a facial lesion.
How does this apply to this situation? If you look carefully at your after photograph, you face demonstrates a classic facial defect caused by your mask lift. The forehead dissection has resulted in atrophy of the fat pads that extend from the temple to the orbital rim. This hourglass hollowing of the temple areas I call the plateau midface deformity. Essentially the loss of the fat volume skeletonizes the zygomatic arch. This little bit of facial fat plays a critical role. This cushion of fat at the side of the face serves to separate the eye aesthetic area from the temple aesthetic area. This slight cushion of volume helps maintain gaze on the eyes. Without this fat volume, the scanning gaze is falls off the eyes and is drawn into the temple area. You are left with the feeling that people are not paying attention to you. Since the primary reason many women (and men) have cosmetic surgery is to stay relevant, this feeling of being ignored can precipitate a narcissistic crisis. The fact that your surgeon cannot understand your concerns (and I promise you they really don’t get it) is even more infuriating. Because like you, they don’t see what the issue is, you get treated like a problematic, ungrateful, impossible to satisfy (insert your own description here) person. Naturally this can precipitate a break down in the doctor patient relationship.
In the example shown here, surgery was used to correct the problem. Previously placed cheek implants were removed and replaced with a hand carved ePTFE orbital rim implant. The lower eyelid was also lengthened using hard palate graft. Because it is necessary to sew the eyelid closed for a week to allow healing means that only one eye can be done at a time. For some individuals who only have the plateau midface, fillers can be used as an alternative to facial surgery.
First, there is no substitute for an actual personal consultation. Generally for this type of problem the best solution for many is adding hyaluronic acid filler to the area where you have lost volume. These products last quite a while and this can be a workable alternative to corrective surgery. For some, surgery is necessary. The most important thing is to avoid having a fix by doctors who do not understand what the issues are. Unfortuately, if you don’t see it, you can’t fix it.
Kenneth D. Steinsapir, MD
About Dr. Steinsapir
Dr. Steinsapir is a much sought after oculofacial surgeon. He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, fillers and cutting edge reconstructive eyelid and midface surgery. He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including multiple revised cosmetic eyelid reconstructions. He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago. He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two-year cosmetic surgery fellowship in Rancho Mirage. He is widely published and lectures to other surgeons nationally and internationally. He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA. His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities. Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.
To learn more about Dr. Steinsapir’s specialized Restylane treatments, please contact us today.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Droopy Eyes after a Midface Lift
Complications following a midface lift are especially disconcerting because they can affect the basic functions of your eyes. Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason enough to contact your doctor. But sometimes, surgeons panic in these situations and respond with a fix-it mentality and may be encouraging you to undergo corrective surgery immediately. Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may be receiving mixed messages from your physician about the best course of action. However, immediately following your facelift may not actually be the right time to fix the problem.
Undergo a consultation
Before taking any action to correct your midface lift complications, carefully weigh your confidence in your current surgeon. There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see and fully understand the physical issues. Occasionally, the description of what is going on and the actual physical complications are not the same.
If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings. Do not blindly follow the recommendations your original surgeon or any surgeon if their recommendations do not make sense to you. While you may not like your appearance and may be experiencing profound disappointment, these issues are seldom a medical emergency. Don’t commit to a second surgery unless you have a clear understanding of the following:
- what is going on and why these complications are occurring,
- what type of surgery your doctor has planned,
- why a surgical solution is necessary at this time,
- the risks of a second surgery, and
- the probability of success or failure.
The risks of midface and lower eyelid surgery and corrective surgery
Lower eyelid surgery and midface surgery have significant risks associated with them. Your surgeon may not fully understand these risks. If you’re experiencing complications it does not mean that your surgeon did anything below the standard of care. However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.
The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate. Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium. Some of the core papers describe anatomic hypotheses rather than proven anatomic fact. For example, the soft tissue of the cheek is mobile (i.e. it slides when we smile), and the lower cheek is also mobile over the lower half of the face. In this location, the nerves responsible for facial expressions around the mouth travel in such a way that it is possible to safely dissect this plane in the lateral half of the lower face; this is a key aspect to the so-called deep plane facelift.
Similarly, surgeons dissect under the skin and lower eyelid muscle to perform midface lifts. Published papers appear to support the hypothesis that this midface lift technique can be performed without injuring the nerves that feed the eyelids. Unfortunately, a hypothesis is a scientific guess, it does not make an established anatomic fact. There is also clear evidence in published papers suggesting that the nerves that supply the lower eyelid orbicularis oculi muscle travel in this so-called glide plane, which is actually just somewhat mobile fat and loose connective tissue between the cheek bone and the orbicularis oculi muscle.
So why do doctor’s still perform this kind of surgery despite the risks? Despite the inaccurate papers, it is possible to dissect in this plane without significantly altering the nerve supply to the orbicularis oculi muscle in some individuals. Yet others may not do well. This may have to do with how aggressive the surgeon is and the exact nature of the distribution of these motor nerves, which do vary somewhat from person to person. Additionally, when this dissection is carried out laterally into the crowsfeet area, it is also possible to do significant damage to the nerves that provide innervation to the orbicularis oculi muscle in the upper eyelid as well. This is significant because the elements of the orbicularis oculi muscle near the lower eyelid margin are responsible for blinking the eye closed. Without this critical blink function, tears are not moved across the corneal surface properly resulting in dry eye and tearing issues. When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.
The remedy for midface and lower eyelid surgery complications
To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal. In six months or more come back and address the situation with your surgeon if problems persist. By preserving as much of the lower eyelid and not cutting out tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal. While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cosmetic eyelid surgery. Be skeptical of solutions that must be done “urgently” or don’t make sense. While very few of these complications mend themselves, with time it may improve so that less work may be needed than first thought.
About Dr. Steinsapir
Dr. Steinsapir trained alongside the inventor of BOTOX and has performed thousands of BOTOX treatments in Los Angeles since 1988 and recently patented his Microdroplet BOTOX technique. He is a board certified eye surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Stem Cell Facelift vs. Fat Transfers
It is said that every good lie contains a grain of truth. The truth about so-called Stem Cell Facelifts is that fat harvested from your body does contain small numbers of adult stem cells. Taking that fat and transferring it to your face as a fat transfer does place these adult stem cells into the face. However, the promise of the name: Stem Cell Facelift is a lie. The implication is that these stem cells in some way rejuvenate the face. Like fad dieting and get rich quick schemes, the public can’t get enough of this type of hype. You would think at some point people would have learned that if it sounds too good to be true it probably is. You would be wrong. Enterprising cosmetic surgeons have learned this lesson as well. So we are bombarded with new procedures with enticing names that seem so scientific. It would be great if the Stem Cell Facelift was based on science rather than science fiction. Do so-called Stem Cell Facelifts provide facial rejuvenation? Yes, but not because of the adult stem cells in the fat. This is just a new way for cosmetic surgeons to insult your intelligence.
The Real Benefits of fat grafting
The reality is, there is no evidence to suggest that stem cells present in adult fat placed in the face have any impact or role in the effects of volumizing the face with grafted fat. Fat grafting procedures work because about 60 to 70 percent of the transferred fat survives, creating long-lasting volume and this helps improve the appearance of the face because loss of volume over time is an important factor in making one look older as we age.
Fat grafting is a biologically safe procedure because the fat transferred is from your body. It is precisely delivered through a tiny poke in the skin that heals without scarring and the procedure can be done under local anesthesia. The fat transfer in a “stem cell facelift” may be combined with other procedures like a traditional facelift or midface lift. It is more accurate to refer to a “stem cell facelift” as “facial volumizing with grafted fat.”
Fact and fiction
It is true that the stem cells in your body fat can be separated from the fat and, in a test tube at a research lab, be stimulated to develop into other cell types. There is a lot of impressive research being done in this area so we can learn more about important potential medical uses of stem cells. But there is no evidence to support the idea that the stem cells in the grafted fat are stimulated this way when transplanted from one part of your body to another
Finding a doctor who relies on science
The biggest concern with the “stem cell facelift” is not that it’s a bad or unsafe procedure, but rather that the term “stem cell” is a deceptive name that promises something that it does not deliver. When seeking treatment, make sure that your potential cosmetic surgeon relies on science, experience, and skill rather than catchy marketing phrases. Your doctor should be a specialist in facial cosmetic procedures and completely honest about what a treatment does and does not do. Relying on the honest application of skills, proven methods, and experience will help you achieve your goals. Deceptive marketing practices violate the principles that make a good working relationship between the surgeon and the patients, which must be based on well-placed trust and honesty.
About Dr. Steinsapir
Dr. Steinsapir is an expert cosmetic plastic surgeon who has skillfully handled face lift and fat grafting procedures in Los Angeles and Beverly Hills for over 20 years. He is a board certified ophthalmologist surgeon and fellowship trained in oculofacial surgery and cosmetic surgery in Southern California where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert cosmetic surgery provider.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Complications after surgery
Complications following a midface lift and eyelid surgery are especially disconcerting because they can affect the basic functions of your eyes. Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason to be concerned. But sometimes, inexperienced surgeons panic in these situations (even long-in-practice, but inexperienced surgeons) and respond with a shoot-from-the-hip, fix-it mentality, and may push you to undergo corrective surgery immediately. Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may feel pressured to have a corrective surgery. There are certainly times where immediate work is appropriate. Before you agree to such a fix, ask yourself if you are still comfortable trusting your surgeon. In his book Blink, Malcom Gladwell describes the process of “thin slicing;” the way our intuition rapidly assesses a situation. That intuition is ignored at our peril. If the hair on the back of your neck is standing up because your surgeon wants to hustle you back to surgery, ask yourself: are you comfortable with what is being proposed? If you are not comfortable, your best course of action is the natural one―dig in your heals. There are occasional situations that are medical emergencies. However, these are truly rare. There is almost always time for a second opinion.
Undergo a consultation
Before taking any action to correct your complications, carefully weigh your confidence in your current surgeon. There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see, and fully understand the physical complications. Occasionally, the description of what is going on and the actual physical complications are not the same. Fixing complications is specialized business. Even if your surgeon does a lot of primary cosmetic surgery, he or she may be relatively unsophisticated when it comes to repairing surgical complications, especially when this work affects the function of the eyelids.
If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings. Do not blindly follow the recommendations your original surgeon or any surgeon whose recommendations do not make sense to you. Don’t commit to a second surgery unless you have a clear understanding of the following:
- What is going on and why these complications are occurring,
- What type of surgery your doctor has planned,
- Why a surgical solution is necessary,
- The risks of a second surgery, and
- The probability of success or failure.
The risks of midface and lower eyelid surgery and corrective surgery
Lower eyelid surgery and midface surgery have significant risks associated with them. Your surgeon may not fully understand these risks. If you’re experiencing complications it does not mean that your surgeon did something that another surgeon might have done in a similar circumstance. However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.
The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate. Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium. Some of the core papers describe anatomic hypotheses rather than proven anatomic fact. Unfortunately, a hypothesis is a scientific guess―it does not make an established anatomic fact. Lower eyelid surgery through the lower eyelid skin is one example of this. Surgery damages the motor nerves that help support the lower eyelid margin leading to complications that can surprise the unsuspecting surgeon. Naturally, they are not going to say that they are surprised but be assured they would not perform surgery this way if they thought it would cause a problem.
So why do doctors still perform this kind of surgery despite the risks? Despite the inaccurate papers it is possible to dissect in this plane in some cases without significantly altering the nerve supply to the orbicularis oculi muscle. Motor nerve damage to the orbicularis oculi muscle near the upper and lower eyelid margin affects the blink and weakens eye closed. Without this critical blink function, tears do not move across the corneal surface properly resulting in dry eye and tearing issues. When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.
The remedy for midface and lower eyelid surgery complications
To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal. By preserving as much of the lower eyelid function and not cutting out additional tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal. While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cometic eyelid surgery. Be skeptical of solutions that must be done “urgently” or don’t make sense. While very few of these complications mend themselves, with time it may improve so less work than originally thought may be necessary.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Can surgery improve my dark circles?
There are a variety of means to address dark circles under the eyes, and surgery is often the best recommendation. Dr. Steinsapir is one of just a few physicians who make treatment of under eye hollows a major focus their practice. The best course of action always depends on a personal consultation and individualized treatment plan. Let us discuss a few possibilities here.
Dark Circle Surgery Before and After
Filler or Surgery?
In many cases, especially when the presence of dark circles under the eyes is pronounced, surgery may be advisable as the most beneficial option. However, Dr. Steinsapir understands that there are many people who need surgery but are too apprehensive to seek it – perhaps they had a negative prior experience and are emotionally traumatized, or they may not be prepared for surgery for other personal or financial reasons. In these cases, Dr. Steinsapir recognizes the importance of respecting emotional limits, and in order to help those who postpone treatment because they desire to avoid surgery, he developed the Deepfill Restylane method of correcting under-eye deficiencies.
Both fillers for under eyes and surgeries, such as the midface lift and arcus marginalis release, have been demonstrated to be safe and highly effective in treating under eye problems. Find a surgeon who specializes in the treatment of dark circles under eyes to see what he or she recommends. Your doctor should help you decide the best approach that is right for you. When you make your decision, remember that surgery is longer-lasting and may yield more powerful results, while under eye Restylane is a flexible, long-lasting but not permanent, and necessitates little-to-no recovery time, making it a great option for those whose personal or work situation may limit their ability to undergo surgery, as well as those who have a less pronounced need for dramatic treatment.
Whether you and your midface surgeon ultimately decide to opt for surgery, a filler, or no treatment, the key to a successful outcome will be planning an individual treatment and then performing it with skill and precision so that enough treatment is given without overdoing it, and so that the look is natural and suits your face.
How Surgery Helps
Surgery addresses lower eyelid contours that contribute to the dark circle. The effect is a less haggard appearance. While no surgery lasts forever, the effects of surgery last longer than the non-surgical treatments.
Find a facial cosmetic surgeon who specializes in midface and particularly under eye treatments who also has the training, experience, and great results to make him or her highly qualified. This is important because your surgeon will need to customize your surgery. When working in the midface areas, an assembly-line-style treatment approach is not a good idea. The key to a great outcome is careful planning and performance of the surgery to make it suit you on an individual basis.
One problem with the midface area that is frequently overlooked is the descent of the malar fat pad. This worsens the hollow under the eye, the midcheek groove, and even the nasolabial fold. You may interpret what you see as a simple hollowing around the eyes, but often this is truly an entire midface concern. A midface lift can address all of these areas to smooth out your features and restore the fullness associated with youth. Dr. Steinsapir helped pioneer the hand-carved ePTFE orbital rim implants in the midface lift, which greatly improves the area around the eyes.
There are different kinds of midface lifts, and the vertical midface lift can be a great way to lift the soft tissue in the cheek back into the lower eyelid where it belongs.
Another option may be the arcus marginalis release, which is suitable for people who have too much lower eyelid fat while also experiencing an under eye deficiency that creates a hollow. To address this, your surgeon may make a small incision behind the lower eyelid so that the scar is hidden, and then he or she surgically rotates the lower eyelid fat to place it over the orbital rim, filling the hollow naturally and relieving your eyelid of excess tissue. This is a comfortable surgery that should usually be performed under local anesthesia, followed by ten to twelve days of recovery time.
Finding the Best Cosmetic Surgeon
Dr. Steinsapir has had multiple fellowship trainings in both cosmetic surgery and eyelid plastic surgery, making him especially knowledgeable about how general facial treatments interact with specialized eye area treatments. As a specialized eyelid plastic surgeon, he is qualified to customize your treatment in this sensitive under eye area in ways that a generalist may not be able to. Dr. Steinsapir is attuned to your need to carefully decide whether a surgery or a filler is better for you, and he can help you make an informed decision. Contact us today to find out how a private consultation can help you plan a course of action that improves your physical appearance and meets your needs.
Hope for the Plateau Midface Syndrome after Midface Surgery
The shape of our faces and how each region influences other areas on our faces is critically important to not only our aesthetic appearance, but also how we interact with others. If you have had a midface lift, you have probably experienced this first hand. In most cases, this experience is a positive one, and after your midface lift you will find that your facial anatomy improves your appearance and the way others view you. However, Dr. Steinsapir has indentified a new set of complications following overaggressive midface lift surgery performed by apparently well credentialed surgeons. Typically people suffering from this set of complications experience a deterioration in appearance and in more extreme cases actually feel that people no longer look them in the eye during conversation with others. In these cases, you need to seek help from a specialist in reconstructive facial surgery who understands how to correct midface lift complications.
Midface Lift Before and After
What is the Plateau Midface Syndrome?
The “plateau midface syndrome” is an unofficial name that Dr. Steinsapir uses to aptly describe in a few words this constellation of changes after aggressive midface surgery. Those who seek help for this problem often wonder if they are experiencing zygomatic arch erosion – erosion of part of the cheek bone or so-called temporal wasting. Dr. Steinsapir has carefully studied these changes. What is going on is the result of surgical trauma to the fat that cushions the temple area and extends to the edge of the orbital rim. This fat is damaged by aggressive midface surgery where the surgeon tunnels into the midface from the hairline or above the hairline. It is Dr. Steinsapir’s opinion that surgeons who cause this problem likely do not fully understand the damage caused by their surgery. The effect is unmistakable. The temple is hollowed, the bone of the zygomatic arch which was previously hidden by the temple fat becomes exposed. This create a skeletonized look. Because this area looks flat, Dr. Steinsapir has adopted the term Plateau Midface Syndrome to describe the condition.
Another feature of this syndrome is loss of fat at the edge of the eye area. This area at the side of the eyes should have a subtle layer of fat. This fat helps to isolate the eye aesthetic area from the temple aesthetic area. The importance of this cushion of fat is critically in our day-to-day interactions with other people. Gaze scan studies have demonstrated that this cushion of fat helps to hold conversation gaze of the person you are talking to on the eye. When you are aware that the person speaking with you is looking into your eyes, you know they are interested in what you have to say. However, when this fat is damaged by midface surgery, the gaze is no longer held by the eyes. The gaze of the person speaking with you easily slips off to the temple area. The effect is the awareness that people who you speak with are not interested in you or what you have to say.
Facial recognition and interpretation is a complex brain process, so the person looking at you will not be able to describe the issue without training and medical insight, but their brain will still have trouble making sense of your face, and they will lose their focus on your eyes and further lose interest in what you are saying. This is not intentional on their part, but the result of complex neurological functioning. When you experience this complication, what you say will not seem important to others because your eyes will no longer help you deliver your message. The change in your interactions with others may even cause you to become severely depressed.
Dr. Steinsapir has seen a dozen people with this concern and has helped them correct it through custom-designed revisional treatments. The most devastating aspect of this set of concerns is its impact on how others subconsciously interact with you. If your teachers in school were always nagging you to make eye contact during presentations, that’s because eye contact is one of the most powerful and important components of social interactions. The ability of others to make eye contact with you is compromised in the case of the plateau midface syndrome, creating serious problems for you in everyday social and business situations.
Correcting Midface Lift Problems
If you are experiencing this grave problem, the first thing you need to do is recognize it as a problem. In most cases Dr. Steinsapir recommends you try to address your concerns with your original surgeon whenever possible. However, because this problem is caused by a lack of anatomic midface and facelift insight by the surgeon who performed the original surgery, your surgeon may not even be able to admit that there is an issue. Under these circumstances, we suggest you seek out a different midface lift surgeon who has extensive experience, training, education, and proven results in midface reconstruction.
Treatment depends on the individual nature of your results. Typically, the temple and orbital rim volume will need to be custom-adjusted for you in order to reestablish your damaged soft tissue buffer. The method of correction will depend on the severity of your situation as well as your unique facial composition and goals. Solutions include facial fillers, orbital rim implants, and sometimes even a fat transfer to the face.
Dr. Steinsapir Can Help
Dr. Steinsapir has corrected many midface surgeries gone wrong, and he understands that it can be frightening to consider getting more surgery when your first surgery was so disappointing. This is why he encourages you to thoroughly research potential surgeons and visit him at a no-risk consultation where you can expect a caring physician to listen to your concerns and individual story and answer your questions with honesty. Dr. Steinsapir is up-front about both the benefits and limitations of revisional surgery, and he can also offer you hope.
Dr. Steinsapir is both a surgeon in West Los Angeles and associate clinical professor at UCLA, where he is a leader, professor, and researcher. As a caring oculofacial plastic surgeon with experience, education, and valuable resources at his practices in Beverly Hills and at UCLA, he can help you to restore your appearance, communication abilities, and trust in doctors again. Help is possible for the plateau midface syndrome. The first step is calling and scheduling a personal consultation with Dr. Steinsapir. He will assess you and discuss the options that are available to address your particular concerns. Please contact us today.
Should I Get a Midface Lift or Under Eye Filler?
If you are seeking to improve your facial appearance by restoring it to a natural, youthful, and alert look, do not overlook the important difference that midface improvement can make. When the malar fat pad descends on our faces, it shows up in our midface – the triangular area on each side of the nose. This can translate to a loss of volume, hollow eyes, and a tired, haggard look. When there are multiple procedures that can address similar issues, it can be hard to know which one to choose. These are the times when it is especially important to choose an experienced specialist to aid you in your treatment decisions. A cosmetic surgeon who has extensive midface experience will be able to give you the best results regardless of what treatment method you go with, which is why it’s always much better to seek guidance from an expert rather than choose a procedure based on what you find online and then use a doctor whose specialty lies elsewhere.
Midface Lift Before and After Photo
Dr. Steinsapir almost always recommends choosing the least invasive option that addresses your needs, which of course is different for everyone. Often patients seeking a midface lift consultation only need Deepfill Restylane treatment, which is a detailed precise technique that requires great skill yet is minimally invasive, offers little to no downtime, and provides great results in the under-eye and midface areas. At other times when the loss of soft tissue or deficiency in bone projection is profound, Dr. Steinsapir recommends midface surgery, which creates dramatic and long-lasting results.
Benefits for Your Whole Face
Many people don’t realize the extent to which their drooping midface and loss of skin elasticity affects their eyes, which are the focal point of the face. The midface descent and sagging skin detract from our eyes significantly, causing hollow undereyes and lower eyelid concerns. Restylane can address the hollow undereyes, but in cases where midface descent is severe, a midface lift is indicated to restore balance. You may be surprised by the facial improvement possible with a midface lift.
Midface Lift or Restylane?
If you and your doctor opt for Restylane filler treatments, you will need to go in for more treatment periodically, perhaps once a year. This is a great solution for those who need treatment but do not have severe issues. You may benefit from a midface lift down the line but only need Restylane right now. This all depends on the individual.
The midface lift is useful for more dramatic concerns by successfully addressing the way the descent of the midface dynamically impacts the rest of the face. A midface lift can correct deficiencies like the undereye hollow and even address wrinkles, taking years off your face and helping you to feel better.
Ultimately, you cannot determine your solution until you seek professional advice and receive an examination to determine your needs.
A Midface Lift Pioneer
Dr. Steinsapir is an expert in the midface lift in Los Angeles. This procedure has been relatively new over the last twenty years, and Dr. Steinsapir has been at the forefront of its study, development, practice, and perfection. There are a number of midface lift techniques including the arcus marginalis release, tailored lower eyelid surgery combined with reinforcement of the orbitomalar ligament, and the vertical midface lift. Dr. Steinsapir’s approach is to tailor your treatment depending on your unique condition, facial anatomy, and goals. He has innovated new approaches and is widely renowned for his reconstructive midface surgery to fix prior failed surgeries. His solutions include minimally invasive techniques, short midface lift recovery time, and his acclaimed approach of using hand-carved ePTFE orbital rim implants.
Dr. Steinsapir will personally perform all your treatment and never relies on assistants or technicians to perform your treatment. He will work with you closely and keep communication open, so you will not run into any surprises. At a personal consultation he can answer your questions and give you advice based on your individual circumstances. Contact us today to find out how a midface lift or Restylane in Los Angeles can help you achieve the results you desire.