The Problem
The earliest signs of facial aging often appear in the midface area, a triangle defined by the inner and outer corners of the eye and the corner of the mouth. There may be lax and wrinkled lower eyelid skin. Fat bags become prominent, oftentimes casting shadows beneath them. The line of demarcation between the lower eyelid and the cheek (lid/cheek junction) begins to drift lower, as time and gravity exert their effects. The entire eye area appears to enlarge. In addition, the cheek drifts downward and begins to bulge, thereby accentuating the naso-labial fold. The net effect is that of "hills and valleys," rather than a smooth and graceful cheek line.

Background
Traditional plastic surgical procedures have been ineffective in correcting all of the problems, even in combined lower eyelid and facelift procedures. The classic lower eyelid tuck could remove excess skin and fat bags, but could do nothing with the lowered lid/cheek junction. The result would often be smooth, taut skin without fat bags but with a hollow-look to the eye. The traditional facelift, or cheek and neck lift, has minimal effect on the midfacial area, including the prominent naso-labial fold.

In fact, traditional plastic surgical procedures, intent on smoothing skin and removing fat, frequently resulted in taut-skinned, gaunt appearing faces. This, most certainly, was not rejuvenation.

Recent developments
During the late 1990's, there was a sea of change in the philosophical approach of plastic surgery towards treatment of facial aging. We realized that youthful faces were full faces, and that fat itself was not essentially bad. Fat itself was good, although it was oftentimes in the wrong place. Emphasis was begun to preserve fat where possible, to move it to advantageous places on the face and to sculpt it to provide optimal results.

The answer
As a result of these changes in philosophy, a new and sophisticated plastic surgical procedure - the midface lift (or microlift)-emerged to address virtually all the problems of the aging eye in one operation. It is performed solely through an incision immediately below the lashes of the lower eyelid and extends slightly down and out at the outer corner of the eye, thereby mimicking a crease line. Through this incision, the entire midfacial triangle of tissue is gently separated from the bone, lifted vertically, and secured to the bone at a higher level. Fat bags may be trimmed if excessive, but most often the fat is preserved and utilized to "fill in" the lid/cheek junction line. Then, the excess skin is carefully trimmed so that it is smooth. Many dissolving sutures are utilized under the skin surface to produce and hold these changes in place. The skin incision itself is closed with fine surface sutures, which are generally removed within 4 - 6 days.

Expectations
The result of a midface lift is a smoother lower eyelid. Fat bags are removed. The lid-cheek junction is both softened (or eliminated) and elevated, thereby avoiding the "operated upon" hollow-eyed look. Thicker tissues of the cheek are placed over the cheekbone, resulting in an enhancement of the cheekbone with the patient's own tissues. And the naso-labial fold is softened.

How would I look?
One may simulate the results of a midface lift by looking in a mirror, placing a finger on the cheekbone just below the outer corner of the eye and very gently elevating the tissues 90% upward and 10% backward. Note that the upper half of the naso-labial fold is improved. The eyelid skin would be smoother and the fat bags would be gone. It is important to understand that a lengthy naso-labial fold, which extends beyond and below the corner of the mouth, will not be totally improved with a midface lift alone. Also, jowls will not be improved at all. These conditions would require other procedures, oftentimes a facelift.

How is the operation performed?
A midface lift operation takes from 75 - 90 minutes and is performed on an outpatient basis under sedation (twilight sleep) anesthesia, administered by a board-certified anesthesiologist. There is no pain or awareness during surgery and the eyes are closed throughout the procedure. Afterwards, there may be soreness but no pain. One is aware of feelings of swelling, pulling and tightness - but there is no pain. There is usually a period of swelling, which lasts 48 - 72 hours, after which the swelling gradually diminishes. There may be bruising, which usually disappears within one to two weeks. There will, however, be continued healing under the skin surface, which may last for three to four months. One should be capable of returning to sedentary-type work - perhaps with some camouflage makeup - within seven to ten days after surgery. One may return to vigorous athletic activities within three to four weeks.

What to expect
The results of a midface lift are subtle. The object is to rejuvenate the midfacial area, not to change your appearance. The goal is a refreshed, rested, youthful look without a tell-tale "operated-upon" look The midface will be full, graceful, and continuous, without "hills and valleys."

While the midface lift does not address all facial areas, when it is combined with a modern two- or three-layer facelift, it adds a certain smoothness to the area around the outer corner of the mouth by providing a vertical lift with the midface and a lateral lift with the facelift. The net result is that the corners of the mouth and it's attendant accessory cheek lines, wrinkles and jowls, are all improved to provide a very youthful appearance.

For those who have had prior lower eyelid surgery prior cosmetic lower eyelid surgery does not prelude a midface lift. Indeed, a midface lift is often used as a reconstructive or rescue procedure to improve the results of prior surgery, such as inadequate removal of skin, over- or under-removal of fat, a low-placed lid/cheek junction or prominent naso-labial lines. Obviously, a decision for surgery is based upon very careful and individual assessment of the problems presented.