Midface Lift: Which Type of Cheek Sagging Is It Right For?

Cheek sagging is not merely an issue of the skin's surface; it involves the descent of cheek fat and underlying supporting structures. At Seorae Plastic Surgery, the midface lift elevates tissue upward via the conjunctiva inside the lower eyelid. Here is an overview of the expected changes, cases where it may not be suitable, and potential side effects.

When cheek fat descends, nasolabial folds can appear deeper. This conceptual illustration is provided by the clinic's website and does not depict an actual patient.

What is a Midface Lift?

The midface lift at Seorae Plastic Surgery is a procedure that elevates descending cheek tissue upward through the conjunctiva (the thin mucous membrane) inside the lower eyelid. It is also referred to as midface lifting.

Lifting addresses anatomical structures rather than just the surface, aiming to restore descended tissues back to their original position. Because the incision is placed inside the conjunctiva, it leaves no visible external scar lines.

Recommended for Individuals Who:

· Have deepening nasolabial folds due to sagging cheek tissue

· Experience a hollow demarcation line between the under-eye area and the cheek

· Wish to explore options that leave no visible external scars and do not widen the face horizontally

A trans-eyelid midface lift is typically described as an appropriate approach for mild midfacial ptosis. A retrospective study reviewing 124 patients who underwent this procedure transconjunctivally also recommended more traditional approaches for those with excessive skin redundancy or prominent under-eye festoons; therefore, an in-person assessment during consultation is essential.

Why Do Cheeks Sag, and How Are They Lifted?

Cheek sagging occurs when the supporting structures holding the cheek fat become lax, causing the fat pad to descend. Anatomical studies report this descent as a key contributing factor to the characteristic appearance of an aging face.

The midface lift at Seorae Plastic Surgery accesses tissues transconjunctivally to elevate cheek tissue vertically, aiming to restore cheek volume upward without widening the facial width. However, outcomes may vary depending on individual tissue characteristics.

Vector of elevation upward from inside the lower eyelid. Conceptual illustration provided by the clinic's website.

Expected Changes from a Midface Lift

· Descended cheek volume is restored upward toward the cheekbones — Anatomical studies indicate that releasing retaining structures and elevating cheek tissue vertically can reproduce a more youthful facial architecture.

· The hollow hollow/demarcation between the under-eye and cheek can be softened — A small study reporting 12 transconjunctival midface lift cases highlighted the procedure's advantage in smoothing and blending the concave transition zone between the lower eyelid and cheek using adjacent tissues.

· Changes are focused on the cheeks, under-eyes, and nasolabial folds — A study evaluating vertical midface lifting via an alternative incision in 116 Asian women reported higher improvement scores in the malar area, tear troughs, and nasolabial folds compared to the lower face. Jowl and neck laxity fall under the realm of other lifting procedures.

· Midface hollows are evaluated separately — Midfacial aging involves both ptosis and volumetric deflation; lifting specifically addresses ptosis. In a randomized controlled trial of 56 patients with a negative vector (where the globe protrudes anterior to the cheek) undergoing subperiosteal surgery, patient satisfaction was higher in the cohort receiving concurrent fat grafting alongside the lift.

Informational image produced by Seorae Plastic Surgery. Surgical outcomes and longevity vary among individuals, and potential side effects may occur.

Diagnosis precedes the technique. The thickness of the SMAS (superficial musculoaponeurotic system) and subcutaneous fat layer, skin elasticity, and the extent of laxity differ for each individual; thus, no single method can be definitively labeled as best. As classification systems suggest surgical approaches based on the degree of midfacial ptosis, the optimal technique is determined only after evaluating your individual anatomy.

Potential Side Effects and Postoperative Care

The following reactions or side effects may occur after surgery:

· Swelling and bruising — Swelling and bruising may develop around the surgical area.

· Ocular discomfort — Because incisions are made inside the conjunctiva, chemosis (conjunctival swelling) or a foreign body sensation may occur.

· Eyelid malposition — Alterations in the resting position of the lower eyelid may occur.

· Scarring — Scar tissue may form along the incision site.

· Temporary nerve impairment — Sensation or motor function around the surgical site may be temporarily dulled.

· Secondary procedures — Additional touch-ups to excise remaining skin or secondary surgery using alternative methods may occasionally be required.

Individual variations apply. If unusual symptoms persist for several days, please contact the clinic promptly. Suitability, recovery progression, and potential side effects vary based on individual conditions; please consult with a specialist during your clinical visit for comprehensive details.

Information to Share Prior to Surgery

· Prominent lower eyelid festoons or substantial excess skin — Other surgical approaches may be considered instead of a transconjunctival midface lift.

· Significant midface hollowing or a negative vector (eyes projecting further forward than the cheeks) — The addition of fat grafting will be evaluated during consultation.

· Propensity for scarring — Although rare, scar-related complications have been reported, so please inform us in advance.

All other health factors will be thoroughly reviewed during the consultation. Surgical candidacy will be determined following a consultation with Dr. Seok-gi Lee at Seorae Plastic Surgery.

The surgical approach is decided after assessing your tissue characteristics. Detailed information, including pricing, will be provided during your consultation.

Frequently Asked Questions

Q. How does a midface lift differ from a thread lift?

A thread lift is a non-incisional procedure that uses dissolvable threads to suspend sagging skin, whereas a midface lift surgically accesses deep structural layers beneath the skin to reposition descended tissues. The appropriate choice depends on your anatomical condition.

Q. How long do the results last?

Longevity varies based on tissue quality and individual aging rate, making it difficult to define with a fixed timeframe. A personalized explanation will be provided during your consultation.

Q. How long is the recovery period? When are sutures removed?

Recovery varies depending on the surgical site, technique, and individual healing rate. Detailed schedules for stitch removal and swelling resolution will be provided during your consultation, so please let us know if you have important upcoming events.

Q. At what age can one consider this surgery?

Tissue condition is prioritized over chronological age. Candidacy is determined during consultation based on the degree of tissue descent and skin condition.

Consultation & Reservation Information

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References

· Yin VT, Chou E, Nakra T. The transeyelid midface lift. Clin Plast Surg. 2015;42(1):95-101. PMID 25440746.

· Gamboa GM, de La Torre JI, Vasconez LO. Surgical anatomy of the midface as applied to facial rejuvenation. Ann Plast Surg. 2004;52(3):240-5. PMID 15156975.

· Correa BJ, Eisemann B, Eisemann M. Transconjunctival midface lift: a "hole" different fixation. J Craniofac Surg. 2013;24(3):987-91. PMID 23714929.

· Zou C, Liu Y, Wang X, Wang T, Wang J. Vertical Midface Lifting: An Improved Technique for Asians. Dermatol Surg. 2020;46(11):e88-e95. PMID 32079870.

· Seitz IA, Llorente O, Few JW. The transconjunctival deep-plane midface lift: a 9-year experience working under the muscle. Aesthet Surg J. 2012;32(6):692-9. PMID 22859542.

· Quatela VC, Ahmedli NN. The Selection of Facelift Approach on the Basis of Midfacial Ptosis. Facial Plast Surg. 2021;37(2):149-159. PMID 33657627.

· Barone M, Cogliandro A, Salzillo R, Ciarrocchi S, Abu Hanna A, Russo V, Tenna S, Persichetti P. Midface Lift Plus Lipofilling Preferential in Patients with Negative Lower Eyelid Vectors: A Randomized Controlled Trial. Aesthetic Plast Surg. 2021;45(3):1012-1019. PMID 32964282.

This article provides general informational guidance prepared by Seorae Plastic Surgery based on PubMed-indexed scientific literature and internal clinical protocols; it does not guarantee specific diagnostic or therapeutic results. Some referenced studies utilize different incision methods or surgical planes than those performed at Seorae Plastic Surgery. Treatment outcomes and recovery durations may vary based on individual physiological factors, and potential adverse effects may arise. Please consult with a specialist during your clinical evaluation for personalized guidance.

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