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Are All Midface Lifts Done Endoscopically These Days?

Is it now common for the procedure to be done endoscopically? Are there any advantages to having mid facelift done NOT endoscopically (can you see more, have more control, precision)? Is it enough the "standard of care" that I should look skeptically at a surgeon who doesn't do this procedure? I'm thinking of having it done to improve the sagging of my cheeks but not sure its the right procedure.

Asked 32 months ago by asiangal in cal in sf, ca

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Many different types of midface lifts

Below is a chapter on midface lifts. There are many different types, depending on the desired effect. Midface lifts performed through a subciliary incision (i.e. USIC, ultrashort incision cheeklift) target the eye-cheek junction. Subperioseal operations througha subciliary incision do the same. Midface lifts through the temple and mouth aim to elevate the cheekpad upward and to the side. This would include endoscopic lifts in my opinion. Modern facelifts with multivector pulls aim to... more

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Brent Moelleken, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

Interesting question

When you ask "standard of care" questions, it sounds like you are an attorney! That said, they are different techniques for addressing the same area, but with different goals (slightly). Either may be appropriate given findings at exam. For myself, I like the open approach for the midface generally speaking, so I will only address this part of your question. Open technique will allow for removal of excess skin. Also, the SMAS (strength layer under the skin, and over muscles)... more

Scott E. Kasden, MD

Dallas Plastic Surgeon

ASAPS ASPS

Be careful what you wish for

Dear Asiangal First, it is important for you to understand that all midface surgery is so individualized that no one can exactly predict the outcome of the procedure. Essentially, it represents a type of surgical experiment. This means the potential outcome and your satisfaction are unknown and unforeseeable! Second, with the exception of my published method of performing a vertical midface lift through the lower eyelid, all other midface surgeries involve pulling up the cheek fat from a... more

Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon

The key is chosing the correct procedure

While endoscopic surgery can offer good results with sometimes less recovery and scarring, there are times when there is no substitute for an open technique. The goals of a midface lift are often only acheived when the midface is lifted and the contour is matched with the lower eyelids. This sometimes requires removal of excess eyelid skin and redraping of lower eyelid fat. This is not typically possible with endoscopic techniques.

John K. Wakelin III, MD

Columbus Plastic Surgeon

ASPS

Mid facelift can be done endoscopically or open

A mid facelift can be done endoscopically or open depending upon the surgeon’s choice. An additional procedure that works quite well for volumetric augmentation of the cheeks is a cheek augmentation procedure. Silastic implants are placed through a gingival incision to volumetrically augment the cheek area. Cheek augmentation is a reversible procedure, as the implants can always be removed. Mid facelifts can make the eyes look smaller.

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William Portuese, MD

Seattle Facial Plastic Surgeon

Midface lifts can be performed open or endoscopically

All midface lifts are not done endoscopically and there is no "standard of care" for techniques. I would be more suspect of someone who tells you that any particular operation needs to be done any particular way. There are advantages and disadvantages to every technique and no specific technique can guarantee a result. The miface is a confluence of the lower lids, cheek, and nasolabial folds. This area of the face must take into account the complex anatomy of the skin, fat,... more

Charles K. Lee, MD

San Francisco Plastic Surgeon

ASAPS ASPS

No, there are many approaches

Looking at your photo, even with a slight smile, your cheek soft tissues are sagging. The good news is that you do not have jowls, or loose skin on the neck and it looks that you have good skin elasticity. I prefer to do a mid cheek lift via a small incision in the gum line just above the teeth. There's also a small incision in the temporal area in the hair bearing scalp (I part the hairs, do not shave them). I often combine a mid cheek lift with a lateral brow lift done through the scalp... more

George Marosan, MD

Bellevue Plastic Surgeon

ASAPS ASPS

Many techniques

Midfacelifts are performed in many different ways. There really isn't a procedure that qualifies as the standard of care as with most facial plastic procedures. I prefer a midface lift via a percutaneous technique with gortex suture, however, endoscopic lifts are also commonly performed.

Kevin Ende, MD

Manhattan Facial Plastic Surgeon

Open midface lift is most commonly done and has advantages

Most experienced surgeons are still using traditional open face lifting techniques. There are many complex reasons, but the most important are that traditional methods produce a more reliably excellent result and in my opinion are safer. The open approcah allows for more accurate re-draping of the cheek and skin, removal of damaged excess aged skin, and a more thorough restoration of the youthful cheek by restoring the malar fat pad to a proper position. Limited visibility through the... more

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Brooke R. Seckel, MD

Boston Plastic Surgeon

ASAPS ASPS

It is the right procedure for you!

First and foremost, from you photo, you look like an excellent candidate for a mid face lift. You cheeks have fallen and you have developed a crease above your Nasolabial fold. You do not have jowling or loose skin in your neck. You still have fullness but it has migrated south. Doing a mid face lift will correct your problem without needing a more extensive face lift at this time. As far as how the procedure is performed, some surgeons use a endoscope and others do not. This however should... more

Leslie H. Stevens, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

Midface lift should not be done endoscopically.

Hi! 1) Offering a midface lift to the appropriate patient is "standard of care" for a plastic surgeon treating the aging face. 2) In New York, we do a midface lift with an incision in the temple behind the hair and an incision inside the mouth. It's done under direct vision with fiberoptic lighting, and there are no visible scars. There is no role for endoscopy. (We do endoscopic brow lifts, but that is another issue.) 3) You look like a good candidate for a midface lift. ... more

George J. Beraka, MD

Manhattan Plastic Surgeon

ASAPS ASPS

It depends on the surgeon and the surgery.

You do look like you would benefit with a cheek lift. How it is done is very important and you should choose a very experienced surgeon who has done hundreds of these. He will be able to guide you as to the pros and CONS of each way of doing the operation. We do all of the various approaches and tailor the operation to the patients goals. A good surgeon will discuss multiple ways of doing the operation and his results with each.

Toby Mayer, MD

Beverly Hills Facial Plastic Surgeon

Endoscopically not the norm

There are any number of approaches to the midface. Many surgeons make a temporal hairline incision then bluntly dissect to the cheek. Then either a suture or a dissolvable anchor is used to support the cheek to the deep temporal fascia. As a surgeon who has done a lot of facial cosmetic and trauma surgery I use an upper eyelid incision and one in the mouth. This has the advantage of giving me great access and avoids the temporal branch of the facial nerve which is a concern with the... more

Christopher L. Hess, MD

Fairfax Plastic Surgeon

ASPS

Mid-face lift is a generic term

Mid-face lift is a general procedure that is not a specific operation done in a specific way. Each procedure done should be planned to achieve a certain task whether it is to lift something, remove something, or increase volume. The methods of executing these procedures should be individualized for each patient. Each surgeon has his own way of looking at cosmetic issues and you should discuss this with him and be in tune with his analysis and approach. If a procedure can be performed with... more

Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon

ASPS

Surgeon and patient preference, individual anatomy dictate the way to go

Hello Asian Gal, You have posed a very good question. While endoscopic mid-facelift procedures certainly do represent a proven and effective way to surgically address concerns of the mid-face (sagging cheeks, fat pad descent), it is not the "only" or "best" way to approach the mid-face. Additional questions you should be asking of your Surgeon is how experienced they are at doing endoscopic lifts verus traditional "open" lifts. Also ask why they feel one... more

Kamran Jafri, MD

New York Facial Plastic Surgeon

Most true Midface Lifts are done endoscopically

There are really only a few ways to do a true midface or cheek lift. The "endoscopic" approach you mention is done through small incisions hidden behind the hairline; 2 in the temples and 2 behind the hairline above the forehead. Through these incicisions sagging forehead and cheek tissues (upper 2/3 of the face) can be elevated giving the patient a younger appearance. This is sometimes called the "Endoscopic Forehead Midface Lift" or the "Temporal Approach to the... more

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James C. Marotta, MD

Long Island Facial Plastic Surgeon

All midface lifts are not equal

In this day and age when patients and surgeons are looking for short scar incisions , endoscopic facelifts, brow lifts, breast lifts, and abdominoplasties are procedures that have been added to a plastic surgeons armamentarium. It's important to know what procedures your surgeon feels comfortable with and what procedures he recommends. Depending on the patient's needs, I perform midface lifts through the lower eyelid,from a standard facelift incision or through an intraoral incision... more

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Joseph M. Perlman, MD

Houston Plastic Surgeon

ASAPS ASPS

There are different ways to achieve midface lift goal

Mid-face lift is a general term. There is no a specific operation that fits for everybody. there are different procedures that could achieve the goal. The ways of executing these procedures should be individualized for each patient. Each plastic surgeon has his/her own way of looking at aesthetic goals and you should discuss this with him/her and be in tune with his analysis and approach. Endoscopic Mid face lift has been shown that is a very good and reliable way to achieve mid face lift... more