3 surgical options for improving the appearance of the aging midface.

Facial rejuvenation surgery has traditionally focused on the forehead and the lower face, but the mid-face, the region of the face immediately below the eyes, is often overlooked. The mid-face region can be defined by its borders. Above the mid-face region are the bottom of the eye socket and the tear trough. On the outside, the cheekbone delineates the transition from the mid-face to the lateral cheek. Finally, the nasolabial fold forms the inside and bottom border of the mid-face region. 

Within the mid-face region, two important fat pads descend and sag over time, creating a sunken and hollow appearance. The first of the fat pads is the more superficial malar fat pad and the second is the deeper suborbicularis oculi fat (SOOF). 

This aging midface can be treated with fat transfer (option 1) to restore some of the lost volume. We can also consider surgery to lift these fat pads to create a more rested and youthful look. There are two approaches to addressing the mid-face. The most direct approach to the midface is through a lower blepharoplasty approach (option 2). This type of surgery is best suited for the patient who may also benefit from lower eyelid surgery as well. Using this approach, the soft tissue of the midface is mobilized and suspended in a higher and more youthful position. For patients who do not need or want lower eyelid surgery, a hairline approach can be used. The hairline approach (option 3) uses an incision hidden in the hair of the temple region and the midface is freed up and suspended with the assistance of an endoscope for visualization. In either type of surgery, there may swelling for 4-6 weeks.

In summary, the mid-face region is an area of the face that is often overlooked in facial rejuvenation surgery. Correct identification of a mid-face problem that can be addressed together with other facial surgeries can help ensure that you have a stellar result. When there are only mild signs of aging in the midface region, fat transfer is an excellent option. For more advanced signs of aging, mid-face lift procedures could be performed through a lower eyelid incision or through a hairline incision, depending on whether the person has elected to have lower eyelid surgery at the same time or not. A mid-face lift is different than a facelift, which primarily addresses the lower face (jowls) and upper neck. When appropriate, a mid-face lift can be performed together with a facelift during surgery.