My cheeks seem to be falling near the centre of my face, making me look aged. Am I a good candidate for a midface lift? (Photo)

My cheeks seem to be falling toward the center of my face, causing an aged look. I know I can get my face filled but I feel that placement of fat is just as impt as the absolute amt of volume. For example,even if an Olympic gymnast has very little fat in her face,the proportions and placement cause her to be read as a young person. I don't just want a fat face per se. My questions are: Q1:Am I a good candidate for a midface lift+fat transfer? Q2:Why does the face in the third pic 'read' as old?

Doctor Answers 15

Mid-face lift or facial aging

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Thank you for your question about a mid-face lift.
  • You are young, beautiful and quite analytic and possibly perfectionist about your early facial changes
  • You have very slight descent of the soft tissue over the cheek - seen in the 3rd photo.
  • This begins as early as the mid-twenties for women
  • It is impossible to suggest the best treatment for you on-line
  • I ask my patients to bring photos of themselves going as far back as possible,
  • That, a detailed examination and discussion is needed.
  • Although fillers can work, and fat can work I have had young patients who do not want these and want surgery - and have done spectacularly well.
  • We do know that early facial surgery has better long term results, than when delayed.
  • I suggest you see a Board Certified Plastic Surgeon specializing in cosmetic surgery, take photos to compare to photos taken at the consultation. Discuss the pros/cons of malar filler such as Voluma, fat injections and surgery and come up with an individualized plan. Hope this helps. Best wishes.

You do not need a mid facelift.

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The photograph demonstrates an attractive face it does not need any surgery. There is some volume deficiency in the tear trough area that might benefit from filler. I certainly would recommend nothing more aggressive than this.

Consider soft tissue fillers

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Before I would consider surgery you may want to consider soft tissue fillers such as Juvederm Voluma and Ultra.  This could give your the result that you desire without surgery.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Facial Aging

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Dear freesoul,

You do have a decent grasp of your surgical and nonsurgical options. I suggest you consult a board certified facial plastic surgeon to receive the highest-quality in-person knowledge, recommendation, treatment, care and skills available. Keep in mind that tt has been proven that the following features comprise an attractive female face:
Short upper lip
High cheekbones
Small nose
Short distance between the chin and mouth
Large eyes, widely spaced apart
Fine jawline
Petite chin

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Correcting Aging of Your Midface

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Aging of the midface will manifest as sagging of fat down from the prominent cheekbone area to a lower position, resulting in some flattening of the upper cheeks and increasing fullness of the lower cheeks.  Atrophy and deflation of the fat compartments in the cheeks adds to this change in shape from a heart-shaped, triangular youthful face to an older more square facial shape.  You can recreate a more youthful shape by adding either volumizing fillers or your own fat to the upper and mid fat compartments, or by having a cheek or mid-face lift, with or without adding volume, to reposition one's own fat.  However, based on the photos you submitted, I don't think you have any significant sagging of tissue and certainly would not suggest a surgical lift at this time, considering your relatively young age and firm skin.  Therefore, in your situation, the easiest and least invasive approach would be to add volume to your upper cheeks..

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 32 reviews

Treatment of "falling cheeks": Voluma vs. fat transfer.

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Patients with early signs of facial aging such as “falling of the cheeks neat the center of the face” (midface soft tissue descent and deflation) usually don’t require a facelift. These patients can improve/ rejuvenate their facial appearance with either tissue fillers or autologous fat transfer. Juvederm Voluma ™ is an excellent filler designed to address this matter in the office setting in a walk-in basis. Fat transfer to the face is a minimally invasive surgical procedure that requires a short downtime, but has the advantage of lasting longer. Patients with early signs of facial aging should discuss their options with a Board Certified Plastic Surgeon specialist in facial aging treatment.

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 141 reviews

Aging Changes of the Midface Question.

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Aging in terms of an aged facial appearance, begins under the eyes, with deepening of the junction of the cheek and the lower eyelid, usually medially. This is known as the tear trough area. Fine wrinkling occurs under and around the eyelids, then the cheek fat descends and atrophies. Continued laxity is manifested by more visible nasolabial folds, then the corner of the mouth turns down, and the jowl area forms. Neck laxity, further jowl descent and aging changes in the skin follow. After that, there is further loss of fat volume and bone volume of the orbit and maxilla, giving less support to the loosening skin. Sun and smoking hasten these changes.
In the picture shown, the early signs of aging under the eyes contribute to a somewhat older appearance. Fat grafting is effective in reversing these changes.

Robert M. Lowen, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 54 reviews

Mid-Face Volume Loss

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Thank you for posting your photos and questions. It is difficult to say from your photos alone, without knowing more about you, if a mid face lift is right for you. That being said, volume loss in the cheek area is a normal occurrence as we age. Juvederm Voluma XC is the latest filler on the market that targets the treatment of this volume loss. By placing Voluma in the mid face region, it will not only enhance your cheek bones, it will decrease the prominence of your nasolabial folds by lifting the mid face area. In addition you could benefit from filler injected under the eye. This is another area that as we age becomes hollow. 

Fillers are Best Bet

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You do not need any surgery at this point.  Fillers for the tear trough, the malar area or cheekbone, the nasolabial fold, and the pre jowl areas will give you a nice boost.  Fillers to increase slightly your upper lip may be indicated.  The fillers of choice I believe would be Voluma, Juvederm Ultra Plus,  and Belotero.  You ask why the third picture shows age.   The reasons are several including display of tear trough, a distinct lid -cheek demarcation zone, weak malar area, nasolabial folds, and possibly a very slightly weak upper lip.   Nevertheless you look great.   My Best,  Dr C

Cheek concerns

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Only in the third photo do I see your concerns......Personally in your case I would start with a little "Voluma" filler work over the malar are and if this worked nicely and you wanted we could consider permanent cheek implants to elevate and augment the cheek/malar area and give you a more youthful look. All this work including the cheek implant work is done with simple local anesthesia very easily and safely in the office operating room in less than 1 hour

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