Mid Face lift & Malar Fat Pads?

A midface lift will address your mid-face volume and dropping that occurs with aging. It is best to discuss this in consultation with a plastic surgeon to determine whether this procedure will give you the results you are looking for. Surgeons can be qualified for a variety of reasons, Board Certified by The American Board of Plastic Surgeonsnot ..... Board of Cosmetic surgeonsmember of ASAPSyears of experiencereferral from a friend who is happy

Thank you for your question.  A mid face lift elevates cheek volume that has fallen.  However, with age we also lose facial volume that can be at least partially restored with fat grafting or fillers. I would recommend consultation with a facial plastic surgeon to discuss what option is best for you."This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Malar fat pads can get removed  at the time of any facelift, either by direct excision or by liposuction.  Personally, I think a mid facelift ft adds only expense to a well done full facelift.

The midface can be lifted through various approaches, including via a traditional facelift or via lower eyelid incision and a temporal incision.  The facelift approach uses SMAS tissue plication or a flap to raise the midface.  The lower eyelid incision can use a pre or subperiosteal approach.  Both can have nice results; however, there have been more issues with the lower eyelid approach causing lower eyelid deformities to ask about this if this is the approach your surgeon recommends. 

The mid face soft tissues are represented by a down pointing triangle of the front mid cheek. As the face ages this area loses volume and can be improved by filling it with fillers either commercial or autologous. This only addresses half of the problem in that the mid face also falls secondary to downward gravitational pull. I manage this by performing a formal endoscopic mid face lift. This limited incision technique allows for long term elevation of all the mid face soft tissues in the proper direction. Occasionally a small anatomical cheek implant is placed inorder to improve long term results.

 In our practice, we do not perform a mid face lift because the midface does not descend downward with the aging process. The mid face ages by volume loss over the maxilla and cheek pads. For that reason, we prefer placement of small Silastic cheek implants to the maxilla to give added volume replacement. Cheek implants are manufactured in a variety of sizes and shapes, are inserted through an intraoral approach under a brief general anesthetic and give a permanent augmentation to the cheek area. For many examples  and more information, please see the link and video below

A transtemporal midface lift gives a subtle lift to the deep and superficial Malar day pads.  This is not super impressive or long lasting but the incisions are hidden.  The more impressive long-lasting and durable is the extended modified keep playi long-lasting and durable is the expanded modified deep plane cheek or face lift.  This can be done on old or young patients under local anesthesia but very few people in the world do it fully 

During a mid facelift the malar fat pads might be repositioned, and or fat might be added through fat grafting. For the right candidate, a mid facelift can provide a beautiful result that can restore a youthful freshness.  Look at many, many before and after photos when considering a surgeon.  It may be helpful for both you and your surgeon to provide photos from your youth to examine the aging changes and what bothers you together. Then, your surgeon can design a surgical plan based on your goals. 

There are many techniques to a mid face lift. Most techniques, however, result in repositioning of the malar fat pad to a more youthful higher position in the face. 

Themid cheek is the area of the cheekunder the eyes, between here and the upper lip. It is a most visible andimportant part of the face and when just right gives a positive healthy, attractive and youthful  look to the face. Just think of the actress, Cate Blanchett. Unfortunately,some people, usually for hereditary reasons, do not have a well developed bonestructure of their mid cheek. This automatically limits their attractiveness and predisposes the person to the tired look associated with premature aging.The fat layer under the skin here is called the malar fat pad and is thicker than elsewhere. If not projected forwardby good bone structure the fat pad soft tissue, tends to sag; at least it looksthat way.

A mid face lift is performed throughthe lower eyelid, which is usually involved in the premature aging, forming lidbags. The lower lid aging  is corrected as part of the cheek correction below. The direction oflift of a mid cheek lift is purely vertical, so the benefit is localisedto the mid cheek and it does not benefit below and to the side. In my experiencethis procedure is indicated for people who have most of their aging in thisimportant area, and the deficiency of bone structure is corrected at the sametime by using a cheek implant.



Althoughfactory made, synthetic implants of silicone and porex are most often used andare very good, but my preferred implant material is coral, which is naturallyoccurring. I have used this in the mid cheek correction of over 600 patients because of  its favourable biology and the flexibility to individualise the result.The coral used is microstructurally identical tofacial bone and  purified to become hydroxyapatite, the mineral of bone. Thecoral comes as small granules, which the surgeon places on the surface of thedeficient bone and moulds it to the desired shape for the individual personsface. Obviously the shape is different for women and men and has toaesthetically balance with the other facial features. Over time the persons ownbone grows into the coral implant so there is not any concern about anyproblems of infection or rejection in the long termas there can be with silicone.

Soif someone has that bone deficiency a permanent correction is obtained .



However,more often the midface deficiency is part of overall facial aging. With theadvances in facelift surgery, it is now possible to add a good midface lift withthe facelift so the whole face is refreshed. The cheek implant augmentation canalso be performed through the facelift and surgery on the lower lid not required.This has the advantage of avoiding the slower healing associated with fulllower lid surgery. The vector of tightening of the facelift on the mid cheek isup and also out. You can see the benefit of this direction of lift when pullingyour cheek in this direction as you look in a mirror. This direction optimises the ‘lift’ over the cheekimplant and has most benefit on the laxity of the malar fat pad.