The Midface has been the focus of great attention lately. The latest fillers that create large amount of volume where previously there was none has been the culprit.It has become an epidemic among Hollywood's finest where their unrecognizable visages are overwhelmed with excess cheek volume. Cases of this include Lindsey Lohan, Joan Rivers and many more. In reality, this epidemic stems from two issues;Newer fillers like Volume and Sculptra are easy to use and add volume for those patients that are losing facial volume over time (this is a good thing).People see the improvement from the outset and get addicted thus losing all judgement when it comes to looking natural.The concerns about mid face stem from several aging issues occurring as we age.The lower eyelid sags leaving a poof of excess skin and muscle at the lower edge of the eye. This is the first component of the shadow that makes people look old and tired.The cheek mound sags as a result of gravity, tissue stretch and muscle pulling (smiling, eating, smoking) that results in the cheek mound sagging toward the floor and toward the mouth (down and in). This sag results in a hollow just below the eyelid, creating a depression that we call the tear trough. With the shadow above and the depression from volume loss the tear trough is the prime component of a tired mid face.Increased pigmentation around the eyes in those of darker complexion makes the entire aging process accelerate.Finally, the muscle that surrounds the eye, called the orbicular oculi muscle can get swollen in some people. This swelling, called a festoon, is very difficult to treat.What are the treatment options.Volume replacement (Voluma, Fat grafting, SculptraRestylane Lyft) are large molecule fillers that can add volume where volume has been lost. Many people say that these fillers lift the Midface, however I am of the opinion that no lifting occurs but the camouflage give the appearance of lift. The downside to these fillers is that with the exception of fat, the fillers are denser than the fat it replaces and as such, during the normal smiling movement, the filler reacts like an unnatural lump of clay and not so much like the cheek fat it is designed to replace.It is this overreach that makes people look like monsters. My advice is to use volumetric fillers as a subtle improvement to restore contour, not to create a cheek mound that did not exist previously. Furthermore, my choice is to use fat grafting, especially in the tear trough and around the cheek because it is soft and mimics the tissue characteristics of a normal cheek (a natural smile).Cheek Lift - a cheek lift or mid face lift is one of the easiest and shortest recoveries of facial rejuvenation surgery. This is ideal for putting the sagging cheek tissue back where it belongs. It will lift the cheek up and outward, lift the marionette lines and get rid of most problems along the jawline. The cheek lift will NOT correct the tear trough along the inner 1/2 of the under eyelid, and for that reason a cheek lift is often joined together with fat grafting to create the best, most natural results.The pigmentation that some people get around the eyes can be improved with skin lighteners, but this is a temporary fix and will need to be used continuously. There is no other treatment that adequately gets rid of tis problem.Finally, Treatment for festoons is not great. In the earliest stages, application of Preparation H can help. As they get worse, some filler at the inferior edge can camouflage the ridge. At its worst, direct excision of the skin and underlying muscle can make it go away, but with the scar. For some patients, this is a good trade-off.I hope this clarifies the considerations around the MidFace. If you have any further questions, please read my book "A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions".
