Full, high cheeks are among the most recognized signs of beauty and youth in our culture. Unfortunately, the aging process gradually reduces the fullness of the cheeks, and many procedures have been developed to reverse this trend. Collectively, these procedures are referred to as “midface lifts”. The “midface” is the area from the lower eyelids down to the level of the mouth. By lifting the soft tissue in this region, the face regains a youthful, healthy appearance. If you feel that your cheeks are less prominent than in years past, or you are unhappy with the “smile lines” that are created by your cheeks, then a midface lift may be right for you.
Midfacial Anatomy . Several types of tissue contribute to the fullness of a young midface, including skin, muscle, fat, and bone. In particular, there is a prominent collection of fat below the cheeks called the “malar fat pad”, and as we age this pad becomes thinner and falls. Also, the high bones of the cheek become smaller over time. These changes, along with the thinning and sagging of aging skin, lead to a loss of soft tissue in the cheek region. Therefore, many midface lift procedures involve not just lifting, but also replacing, the soft tissue of the cheeks.
Types of Midface Lifts . The most extensive midface lift techniques involve making two incisions on each side: one inside the mouth (at the bottom of the cheek) and another in the hair behind the temple. First, the soft tissue of the cheek is freed to allow it to move. Then, an absorbable fastening material is used to lift the soft tissue to a higher, more youthful position and secure it in the temple region. A less extensive, but still effective, method is to lift and secure the malar fat pad through an incision immediately below the lower eyelid. In this approach there is no need for an incision in the mouth.
Suitable Patients for Midface Lift . Patients who benefit from midface lifting have two common complaints. First, they dislike the hollowing, flattening, or loss of cheek fullness that occurs with age. Second, they are unhappy with the prominent “smile lines” (also called “nasolabial folds”) that extend from the sides of the nose to the corners of the mouth. A midface lift can improve both of these features. Ideal patients should also be in good health, and should be able to avoid blood thinning medications around the time of the surgery.
The Consultation . When you arrive at our office for a consultation, you will be asked to complete a detailed questionnaire about your medical and surgical history. Dr. Donath will then take standardized photographs, and examine the position and fullness of your midface. Most importantly, you will be given ample time to describe your complaints, and to learn about your proposed procedure and how it might help you. Our doctors will also use a state of the art computer photo alteration program to predict your surgical outcome.
As mentioned elsewhere in this website, we stress patient education. So, during the consultation, you will learn a great deal about the anatomic considerations that cause your complaints, how they will be changed, what you will experience during the recovery, and your risks and alternatives to treatment. You will be given much information in writing, and we are always available for a second consultation, if you wish to review anything.
The Pre-operative Process . For the two weeks prior to your procedure, you should refrain from using common medications that decrease your blood’s ability to clot, including aspirin, ibuprofen, Advil, Motrin, Bufferin, Naprosyn, and large doses of vitamin E. Our doctors will give you specific instructions based on your current medications. If you have any headaches or other pain, taking acetaminophen (Tylenol) is fine. You should also avoid smoking for two weeks before your surgery. The night before your surgery, you should eat a normal dinner but avoid all oral intake after midnight. This includes drinking anything, even water.
When you schedule your surgery, you will be given a detailed set of instructions that includes much more information. A copy of these Midface Lift Instructions is available for you to review now.
Your Procedure . After you are properly anesthetized, small incisions will be made inside your upper lip and in the temple hair on each side. Alternatively, you may need only small incisions in each lower eyelid, under the lashes. Next, the soft tissue of the cheeks (usually the malar fat pads) will be grasped by absorbable sutures or thin absorbable plastic strips. The suture or strip will then be secured to the deep temple tissues, or strong tissue under the lower eyelids. The result will be an elevation of the cheeks to a more youthful and fuller position. Some patients are also helped by the injection of a small amount of fat into the cheeks, to replace soft tissue that has been lost with aging. This fat is often harvested from the abdomen.
You will need to arrive about two hours prior to the start of your procedure. The entire procedure will take approximately two hours, and you will stay in our recovery room about one hour while you recover from the anesthetic. When returning home, you will need a friend or family member to accompany you.
Anesthesia . Most midface lift patients receive a deep sedation, which means they are completely asleep during the procedure but are breathing on their own, so there is no need for a breathing tube. This type of anesthesia is always provided by a highly qualified doctor or nurse anesthetist, who will be dedicated to the anesthetic treatment for the entire case. Every patient will be completely comfortable and the procedure itself will be pain-free.
Recovery . The discomfort after a midface lift is usually very mild. You will be provided pain medication and other suggestions to minimize your soreness. Most patients report a sensation of heaviness and tightness in their cheek skin, which arises from swelling. Actual pain, though, is fairly rare. Usually there is no need for a dressing.
The sutures used for your skin incisions will be removed one week after surgery. You will have mild swelling and bruising of your face for one to two weeks. You should be able to return to light activities after your sutures are removed at one week, but heavy exertion and exercise should be avoided for up to three weeks. You should keep in mind that your cheeks may look too high or full immediately after surgery – this is a normal consequence of swelling, and will resolve.