A midface or cheek lift is an effective technique when performed alone or in conjunction with other procedures to reduce lower eyelid hollowness.
Several different techniques for midface lifting exist, albeit an eyelid approach will offer maximal improvement of lower eyelid hollowing and smoothing of the eyelid-cheek junction. The eyelid approach can usually be performed through a small incision at the outer corner of the eye. The remainder of the incision is hidden on the inner aspect of the eyelid, unless lower eyelid skin needs to be removed. Sometimes an incision in the mouth at the gum line is used to help re-position the cheek.
Elevation of the cheek will result in upward movement of the underlying fat towards the lower eyelid area. The fat can then be positioned to soften the eyelid cheek junction, and restore fullness of a hollowed lower eyelid. In some instances fat grafting to the lower eyelids is also performed for maximal improvement.
The patient should remember that lower eyelid hollowing can be due to a deficiency of the cheek and orbital bones and not fat. In this instance an implant may be placed underneath the lower eyelid or cheek to improve the hollowed appearance.
Adam J. Cohen, MD, FACS