Subperiosteal midface lift made me look like acromegaly patient. How to reverse this? As swelling goes down, it looks worse!

Doctor Answers 3

Subperiosteal midface lift made me look like acromegaly patient. How to reverse this? As swelling goes down, it looks worse!

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 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  I find that the subperiosteal facelift pulls facial tissues at a 45 degree angle and as such can result in elevated corners of the eyes and mouth while broadening the outer cheek area.  For those reasons, I don't use this facelift technique.  Non smiling photos of your face as it is now and before the facelift from the front and side would help in the evaluation.  If the cheeks have been broadened and sufficient time (4-6 months) has elapsed to account for the extensive swelling associated with the subperiosteal type facelift, attention should be turned to softening the anterior (front) section of the cheeks.  This areas should be thought of in terms of three dimensions: Bone, overlying fat and skin.    Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed. My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.


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There are few indications for a subperiosteal facelift. It is a powerful type of facelift that requires expertise.Wait till all the swelling has disappeared then you can judge. May require another facelift to correct any problems you have

Samir Shureih, MD
Baltimore Plastic Surgeon

Swelling after midface lift

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I have found that the term "midface lift" can mean different things to different people. The subperiosteal midface lift can, in the right patient, be a powerful tool to rejuvenate the lid cheek junction, midface, and even jawline. In my experience, however, this procedure does lead to significantly more swelling than other types of lifting procedures - and the swelling seems to last longer. The key question I have is: how long ago was your procedure? It can take quite a few weeks for folks to look "normal", and I suspect you may be seeing early signs of persistent swelling. It is usually worth it in the end, so I encourage you to visit with your surgeon to make sure all is ok, but trust in the healing process.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.