Forehead lifts smooth the forehead and elevate the eyebrows, facelifts smooth and tighten the jaw line and lower neck, and eyelid surgery improves the eyes. Midface surgery is aimed at improving the midface area, which is a triangular region of the face on either side of the nose. The primary concern here is a descent of the malar fat pad contributing to the under eye hollow as well as an increase in the depth of the nasolabial fold. Various approaches exist to address this area, which will be discussed below.

Examples

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Midface Lift

Like all facial issues it comes down to skin quality, bone projection, and soft tissue laxity. In the midface area the bone is the cheekbone including the zygoma and the maxilla. These bones meet in the cheek and contribute to the prominence of the cheek. The cheek should project as much as the brow does. However, there are many individual where the cheek is relatively flat or even under projected.

The fleshy pad of the cheek is known as the malar fat pad. In youth, this pad was held high in the cheek before the ligaments holding it in place slowly gave way over time. This can be the jarring effects of running, or simply the effects of gravity over time. As the malar fat pad falls, it tends to collect in a couple of spots including the nasolabial fold and the jowl area of the jaw line.

Dr. Steinsapir has found that for many individuals volumizing the midface with Restylane® and Perlane® are highly effective at treating almost all midface deficits without the necessity of surgery. These treatments last on the order of about a year. However, it is critical to get enough product in order to have a satisfactory result. How much filler is needed is an entirely an individual consideration. Dr. Steinsapir will assess you and make a recommendation. Some will elect to do less treatment because of financial limitations. Dr. Steinsapir will work with you to get the most from whatever service you decide to afford yourself.

Facial volumizing with the Hyaluronic sugar gels is less expensive than having surgery. Yet volumizing can accomplish results that can’t be obtained with surgery. Surgery and surgical recovery is avoided. For many, the downtime associated with surgery is a big consideration. These noninvasive methods truly provide a fantastic alternative to having midface surgery.

Midface surgery includes a range of surgical options. A surprisingly effective midface option is a medium depth chemical peel that includes the lower eyelid, crowsfeet area and is feathered out over the cheek. Typically, phenol 89% is used for this purpose. Dr. Steinsapir is a master chemical peeler. These treatments are comfortably performed under local anesthesia. Recovery for this peel is 8 to 10 days before the skin is intact and able to hold makeup. Redness persists typically 6 to 8 weeks. While the redness is generally not an issue for men, women usually prefer to cover up the redness. The lower eyelid peel can be combined with a full-face peel for a truly awesome treatment with a very acceptable down time. The peel firms the lower eyelid skin tightening the midface and reducing lower eyelid fullness.

More invasive options for the midface include arcus marginalis release where the lower eyelid fat is surgically rotated over the orbital rim to fill the under eye hollow. The surgery is performed from a small incision behind the lower eyelid and is comfortably performed under local anesthesia. Typically 10 to 12 days are required to recover from this procedure.

Significant midface issues are addressed with a vertical midface lift over a hand carved ePTFE implant. This procedure is very effective for midface deficits following trauma, and prior lower eyelid and midface surgery. Swelling from this procedure persists 2 to 3 weeks or longer but many feel ready to return to work in 10 to 14 days. A personal consultation with Dr. Steinsapir will determine if you would benefit from this procedure.