Mid-Face or Cheek Lift Rejuvenation Surgery: An Essential Part of Facelift Surgery that Few Physicians Perform

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Surgical rejuvenation of the mid-face or cheek is an often ignored part of a facelift. It requires special skill, knowledge, and training to achieve a lasting result with surgery of the cheek at the time of a facelift. And restoration of the mid-face structure is one of the principle items that gives a “natural”, youthful facelift appearance.

I am writing this blog, as a recent patient told me that she had had a mid-face lift years ago with a wonderful result. When she talked to surgeons in Phoenix (her original surgeon was in Phoenix) they informed her that mid-facelift surgery “did not work”. She knew that that was not true (she had a previous great experience), so decided to consult with us.

A SMAS facelift cannot restore the mid-face structure that results from fallen fat and muscle. Even deep plane facelifts (we perform these) cannot fully restore the natural result in the cheeks that a mid-facelift does. The mid-face, or cheek is an area that needs to be treated separately to achieve an optimum natural result. Falling of the mid-face leads to hollowing of the cheek, a “tear trough”, and, often, an increased distance from the eyelashes down to the bottom of the lower eyelid, and a fullness of the nasolabial folds.

In my hands, mid-face lift procedures last from 5 to more than 15 years. While there may be some descent after 5 years, the structural restoration effects of mid-face rejuvenation usually go on much longer.

While many surgeons and physicians attribute mid-face aging to “volume loss”, most of the “loss of volume” in the cheek is due to the gravitational descent of the mid-face fat and muscle, as illustrated in the figure below. The ligaments that hold the fat and muscles upward and attach them to the cheek bone, loosen with age and repetitive facial motion, causing the cheek volume to descend downward over the folds that go from the nose to the lips and the lips to the cheeks. There is often a concomitant “volume gain” in the jowls.

While there is some minimal cheek volume loss in patients in their 40’s, 50’s, and 60”s, the primary problem (documented by MRI studies) is that the fat in the cheek descends downward; so called “gravitational descent” of the cheek. As these sagging structures fall over the folds that extend from the nose to the mouth (nasolabial folds), they produce a “tired” appearance.

Many surgeons inject the cheek and mid-face with fat to camouflage the gravitational descent that occurs. This is usually not a permanent solution, and, in fact, can sometimes lead to an “over filled” appearance. Fat injection into the mid-face has only a 30% chance of lasting a year, and may need to be repeated or replaced with facial fillers.

Long lasting correction of this structural problem is important, because, when we glance at a person for a first impression, our eyes first gravitate to the middle of their face. By gazing at this area from the eyelids to the upper lips, our brains decipher whether a person looks old, tired, mad, sad or youthful.

In summary, I feel that every facelift (deep plane facelift, or other facelift) should have a cheek lift (mid-face lift). This restores the structures of the face to a younger appearance. The combination of facelift or deep plane facelift, cheek lift (mid-face lift) results in a natural facelift that restores a patients natural beauty or appearance and avoids the dreaded “facelift” look.