There are basically several types of midface lifts / cheeklifts. Each does a different thing. The cheek is the trickiest area on the face, and if incorrectly done, they can be a disaster. However, the aesthetic rewards are enormous in that the cheeklift is a powerful tool. There are the through the lower eyelid surgeries. These are best at smoothing out the eye-cheek junction. They are riskier if they violate the orbital septum. Our version is an ultrashort incision procedure that does not violate the orbital septum, the USIC(TM) cheeklift. Through the lower eyelid cheeklifts can be done at the suborbicularis level or the subperiosteal level. We believe the suborbicularis level (more superficial) is safer. We often combine the USIC cheeklift with LiveFill(TM) grafts to the lower eyelid, but very judiciously to minimize the chance of bulging. There are mini versions of these procedures, and maxi versions. Each has a place in the right patient. Cheeklifts can be performed through the temple / inside the mouth. These cheeklifts completely avoid lower eyelid problems, but also do not correct the eye-cheek junction. They can cause an increase in the intermalar distance, the distance between the cheeks. They can also cause a upward of "catlike" appearance of the outer eye. They are powerful in what they do and valuable in the right patient. Endotine type lifts are also cheeklifts. These can be performed through the temple. Hooks of self dissolving material are placed below the cheekpad, elevating it. Patients note sensitivity to the endotine devices or the fixation devices. Bunching in the side of the eye can be noted. An alteration in the distance between the cheeks can occur. Transconjunctival approaches. It is possible from the inside of the eye to elevate the cheeks slightly and to redistribute the fat from the lower eyelid. If the fat is redistributed, this requires that the orbital septum be violated (from the inside) to spill the fat our beyond the lower rim of the eye bone. Whatever the approach, experience experience experience is key! The lower eyelid is a very delicate structure and a conservative approach is best. The rewards are great. The pulled down look of the older blepharoplasties can be eliminated in most cases, and certainly prevented by using midface techniques. Almost always, the entire face must be considered, not just the cheek, because the cheeklift has effects on other areas of the face. A beautiful appearance of the lower eyelid area can be created that is simply not achievable with any other means. Bad lower eyelid surgery can generally be fixed nicely. Bad aggressive cheeklift surgery is often unfixable. You may wish to read the chapter we wrote in the plastic surgery textbook "Mathes" on midface lifts and browlifts.