I'm 52 years old and female. I got a mini face lift last spring and look pretty good around my neckline. I also had my lower eyelids done, which look good, too. Problem is just that my mid face looks tired and the skin beside my nose is kinda baggy. When I lift it up with my little finger, it looks great. What can I do to handle this? Are Mid Facelift and Subperiosteal Cheek Lift the same?
Baggy Skin After Mini Lift
Doctor Answers 7
Types of cheeklifts
There are many types of cheeklift. Technically any cheeklift is a midface procedure because it deals with the tissues below the eyes into the cheek area. Subperiosteal is one method of cheeklift. Largely, the subperiosteal cheeklift performed through a lower eyelid incision is falling out of favor because of the chance of pulling down of the lower eyelid, or ectropion, even in highly skilled hands.
In response to the problems that were occurring with the subperiosteal subciliary cheeklift, I invented and published the superficial cheeklift in 1999 in the Journal Plastic and Reconstructive Surgery.
We now have a two new versions, the USIC and the LUSIC, cheeklifts with ultrashort incisions that either use LiveFill (when hollowness is present) or not (USIC), depending on the clinical situation.
Cheeklifts are among the most difficult procedures to perform, so it is my opinion that surgeons should have a special interest in this field before regularly undertaking such cases.
For a complete discussion, you may wish to read our book chapter in the textbook Mathes, posted on our website.
Mid facelift and Subperiosteal cheek lift
A Mid-facelift is a generic term that includes all sort of techniques to enhance the area around the eyes and cheeks.
The subperiosteal cheek lift is one way of doing it. One could also combine a variety of other techniques just to improve the look around the midface area, such as fat grafting, implants, or even deep threadlifts.
What is really important to understand is that the midface is what other people concentrate on when they look at your face.
Midface Procedures Defined
Midface procedures can greatly enhance the overall appearance of the face, whether in isolation or combined with other more traditional facial rejuvination surgeries, such as facelifting or blepharoplasty. Just recently, plastic surgeons have begun to appreciate the significant role of the midface in the aging process.
The midface is the area below the lower eyelid and above the corner of the mouth that lies to the side of the nose. This region is made up the the cheek and facial bones, muscles of expression, and two fat pads; the SOOF (sub-orbicularis occuli fat pad) and the malar fat pad. Descent of the skin and fat in the region leads to hollows beneath the eye (nasojugal grooves), deepening of the nasolabial folds, and downturning of the corners of the mouth. Elevation of the midfacial muscles and malar fat pads helps to rejuvinate the lower eyelid, mouth, and cheek at the same time. Facelifting procedures typically do not address these concerns very well.
Minimally invasive procedures for midfacial lifting include thread lifting and suture lifts. These procedures are excellent for patients with mild to moderate midfacial aging that want to avoid formal surgery and general anesthesia.
Endoscopic midface lifting is also known, as you point out, as subperiosteal midface lifting. This is a more formal procedure which requires general anesthetic. Patients with moderate to severe midface aging are helped tremendously by it. Small incisions are made behind the hairline and the midface is elevated along the facial bones, hence the term sub-periosteal. Sutures or absorbable implants are then placed to hold the midface up until the tissues heal in their new location.
In the appropriately selected patient, midface lifting can produce a very natural and lasting surgical result. The problems you describe seem to be exactly the type that surgeons look for in a midface lift candidate. Obviously, a formal consultation is required to definitively determine if this procedure is right for you.
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The subperiosteal lift is one technique for doing a midface or cheek lift. There are multiple alternatives; the approach selected should be individualized to meet the needs of each individual patient.
In my opinion, a mini facelift gets many results. Of course patient's election is the most important factor. The best way to know the appropriate course of treatment would be for you to visit with your plastic surgeon and discuss her concerns. There is no substitute for communication and a good physical examination.
Mini lift gives mini results.
Unfortunately, in answering question like yours, I make the above statement frequently. I'm glad you had nice results for your neck and lower eyelids. By not doing the entire facelift, your surgeon was not able to address the area that now bothers you. I'll bet the savings of a "mini lift" over what will now end up being two operations, two recoveries, and two times off work or social activities is now costing much more than a single "full" or "standard" facelift!
I must say that I am not a fan of subperiosteal lifts, since I have NEVER seen one patient who has droopy periosetum! This layer is densely adherent to the bone, and while this is an "easy" layer to lift and tighten, it's the deepest layer from the visible surface, and often causes more severe and longer swelling than a SMAS facelift.
Lift and tighten what sags; find an experienced, board-certified (American Board of Plastic Surgery) plastic surgeon (if your initial surgeon wasn't) and listen to good advice. Best wishes!
Not all midfacelifts are created equal
If only we had a surgery that does what can be accomplished by pushing the face around with one's hands.
Many mid-face lifts have an incorrect vector of pull. This includes the so-called subperiosteal mid-face lift. The most common vector of pull is superior and toward the temple. Surgeons like this because the dissection plane is well understood and there is good tissue to sew to in the temple. However there are two problems with this approach. First, the malar fat pad falls vertically from the lower eyelid and not in the direction of pull these surgeries create so the effect is, well, surgical.
Second, the surgical dissection can damage the fat in the temple and at the outer edge of the orbit. This causes a condition I call "plateau midface." The loss of tissue volume skeletonizes the top of the cheek bone. This is a bad thing because the small cushion of fat aroung the outer edge of the eye socket helps to keep conversational gaze on your eyes. When these tissues are damaged, the gaze can fall off the eyes and you end up felling like people you are speaking to are not paying attention.
The answer is to fill the under eye hollow with fillers or to perform a vertical midface lift over an orbital rim implant.