Hi Jams1976,I don't offer midfacelifts anymore, so I won't comment on whether they are worth it or not, I will let the surgeons who still actively promote midfacelifts and cheeklifts give their opinion on why they think it is worth it.I suspect that the dark circles and the cheeks dropping are related. People with high cheekbones will not have dark circles under their eyes. People with dark circles under their eyes will appear to have sagging cheeks. Why? If a person have a dark circle with or without eyebags, then their cheeks will not appear any higher than the bottom of the dark circle/eyebag.Note that the more weight you lose the more it appears the dark circles are worsening and the cheeks are "falling." What is really happening is the fat that borders the lower eyelid fat and the upper cheek is losing volume. This creates a groove below the lower eyelid and the upper cheek which causes the cheeks to "fall" because visually the cheeks cannot be higher than the groove.Interestingly, if you can not see the groove between the lower eyelid and upper cheek, all of a sudden the cheek appears much higher, and it is really hard to tell where exactly the lower eyelid is located. Ideally the cheek appears to begin somewhere between 1/8" to 1/4" below the eyelash line, but if there is significant hollowing then this volume loss is increasing the amount of visible lower eyelid and in turn reducing the high point of the cheek.As people lose a significant amount of weight, the first pocket of fat that gets lost is the buccal fat, which is the "baby cheek fat" which is located under the cheek bone. As this buccal fat is lost often times the tear troughs (dark circles) will develop. A plastic surgeon observed that when buccal fat removal is performed often times the patient may develop tear troughs months to years after the procedure which were not present prior to the buccal fat removal. I suspect that the buccal fat is completely full, a finger of this buccal fat goes up along the side of the nose to help push the cheek fat under the tear trough area fuller and higher. After the buccal fat removal, this finger-like extension of the buccal fat may get pulled down along with the buccal fat reduction resulting in the dark circle. As far as the nasolabial fold getting deeper, this also appears to be a common element with significant weight loss. The smiling muscles (zygomaticus major and minor) when contracting cause the nasolabial folds. There are no (opposing) muscles to relax these smile lines. For example, the biceps flex the forearm to the upper arm, but the opposing triceps extend the forearm relative to the upper arm. The zygomaticus muscles can contract, but there are no opposing muscles to then stretch them out. Currently the treatment for nasolabial folds is injecting fillers directly along this wrinkle/fold. This helps to soften the nasolabial fold, but to my eye more filler does not yield a better result. Sometimes it can look strange when the nasolabial fold is so filled that even when the person is authentically smiling that no nasolabial fold is seen. This appearance looks puffy to me. Ideally when the person is not smiling the nasolabial fold is minimal and when they smile, the person can still form a sharp crease which indicates an authentic smile. If you google image buccal fat pad, you will see that the zygomaticus major and minor lay directly over the buccal fat pad. Is this a coincidence? Perhaps the buccal fat pad volume helps to passively stretch the zygomaticus muscles when they are not actively contracting. When the zygomaticus muscle contract, the fat is no match for these muscles and the nasolabial fold forms. When the muscle relaxes (not smiling) the pure volume of the buccal fat pad stretches out the zygomaticus major and minor muscles so that the fold is not so obvious.Another observation that is that the nasolabial folds always look worse when the same patients have dark circles or tear troughs. The two lines are approximately parallel and visually play off of each other. If the dark circles are no longer there, then the nasolabial folds by themselves are not so bothersome, since the nasolabial folds act as the natural border between the high cheeks (apple cheeks) and the mouth area. Essentially below the lower eyelashes, ideally there are only 3 "sections" the left and right cheeks and the mouth area, with the nasolabial folds being the natural divider between these three sections. If the dark circles are present in addition to the nasolabial folds, then the area below the lower eyelashes then get divided into 5 areas: two lower eyelids with the lower border at the tear troughs, lowered cheekbones bordered above by the tear trough, and below by the nasolabial folds, and the last section which is the mouth area.Since all of the fillers are initially FDA approved for nasolabial folds, the majority of injectors are most comfortable with nasolabial fold filling. Also, due to direct to consumer marketing such as Juvederm for "parentheses lines" that don't belong on the face, patients will come in and ask for fillers in the smile lines even if it may not make sense to fill that area as a first location. If nasolabial folds are filled as a first area, we are essentially trying to leave the dark circles and combine the cheek and mouth area into a single area, and leave the tear trough/dark circles as the second and third area. This doesn't make much sense to me. I suspect when we see people who have had filler in their smile lines, but have other areas which are not filled, our brains notice that there is some mismatch to the way that the face is aging and makes use notice that their smile lines have been filled.If the tear trough/dark circles are improved as much as possible, then the nasolabial folds can be partially improved without drawing attention that one area has been filled while another area has not been addressed.Having made the previous points, I ask the surgeons who perform midfacelifts regularly, can a midfacelift reposition the cheeks enough to hide the tear troughs and blend the lower orbital rim exposure towards the outer part of the eye. Is there enough fat on the upper cheek/orbital rim to position it high enough to create a high cheekbone appearance? Are some of the effects of the midfacelift from prolonged swelling from a subperiosteal (releasing the entire cheek off of the cheekbone) which can give a 6 month period of extended swelling which can look like volume, but when the swelling is fully gone after 12 months the tear troughs and lateral orbital rim do not need any additional volume using fillers or fat transfer. Is is possible to simultaneously perform facial fat transfer accurately to those areas, while performing the endoscopic subperiosteal midfacelift? These are the questions I would want answered if I were the patient interested in a midfacelift/cheeklift.Best,Dr. YangP.S. If you find my answers or other doctors answers to questions are helpful, please +1 those answers to push up the better answers to the top, which helps others who read the same post, get to the more helpful answers first.P.P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. 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