What are the pros and cons of transconjunctival deep-plane mid face lift?

Each patient comes with distinct anatomy and concerns. Without seeing you, it is hard to say the best approach. In general, a transconj approach to a deep-plane midface lift has a very vertical vector of pull, which is not always the ideal vector of pull.Best of luck with your journey. 

Thank you for your question. I understand you’re looking into having cosmetic surgery in the future and you came across a procedure called a transconjunctival deep plane mid-facelift, which involves placing titanium screws into the cheekbones. You’re wondering if this be combined with other forms of facelifts.To give you a bit of info about my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years.Now, with facial aging comes loss of bone, muscle, fat, and soft tissue. As a result, everything sort of collapses and goes inward. Also, is sagging of skin and soft tissue, which is known as descent. In your case, you’re in a place where your mid-face has not actually descended so much as it has deflated, and there’s a big difference there.The challenge of addressing the mid-face with a mid-face lift is that the area is lifted vertically, and the method of using titanium screws or various types of fixation devices at the rim, the cheekbone, or in the temple area, leaves the patient looking too elevated — almost like a chipmunk or a lion. And then often when the cheeks drop, they pull the lower lids down too. As a specialist, I have corrected some of these ideal procedures, and have no problem in terms of comfort in working in mid-face. However, I would say that proportionally, in the mid-face, volume loss is greater than descent and that the rest of the face where the skin sags and there are jowls and loosening of the neck skin, are where a traditional facelift is more appropriate.So it really depends on your situation. In my practice, for someone of your age, I would usually try to address mid-face volume loss with either facial implants, like a cheek implant, or by means of structural volumizing using fillers in the deeper levels of the mid-face area. I do have a more natural aesthetic though. This means that I prefer to restore the structure of the face so that you can be much more conservative with these aggressive procedures, and there is no doubt that a mid-face lift is certainly an aggressive procedure. Sometimes, I’ll do the facelift first and do some volume correction afterwards in order to create the ideal balance where you look like yourself and still look natural.What’s important is that you keep the natural character of your face, and in order to do that, it’s also important to understand that there is a right time and right place to have these issues addressed by a surgeon. Now, if you’re relatively fit and healthy, then you may want to look into just volume correction. It requires regular maintenance, but it will certainly give you a much more natural look than the aggressive vertical lifting of the soft tissue of the cheek through a facelift.I suggest that you meet with experienced doctors who perform these procedures and learn more about these options, as well as gain an understanding about the possible outcomes and risks involved. I think you will find that a lot of doctors will approach the facial aging process differently, so it’s really all about finding the right doctor who you are comfortable with and confident in, so that you can proceed with the solution that fits your needs best.I hope that was helpful and I wish you the best of luck!

This is a very tricky operation when the ligament that separates the lower lid from the cheek is released. It should only be perform by surgeons who do this regularly. Aesthetic problems resulting from this operation are sometimes impossible to fix.