Is there a way to re-suspend the malar tissue which doesn't involve either transconjunctival or intraoral incisions?

I had a subperiosteal midface lift done via an intraoral/temporal incision around 1 year ago, which left me with only partial sensation in my upper lip, on the left side. It also left me with a pronounced malar 'bulging', which I've been told a cheek re-suspension will be necessary to fix. I'm concerned the intraoral approach could risk further trauma to the same nerves. But I'm equally concerned that the transconjunctival incision could result in lower lid retraction.

Doctor Answers 13

Facelift: suspension of malar pad

Facelift: suspension of malar pad
This can be done from a temple approach behind the hairline with or without an endoscope.
Fat grafting may help as well

Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Correction of malar bulging after midface lift.

This is a difficult question to answer without photos, but I gather there is some asymmetry of the malar area, with "bulging". It would seem that a less invasive procedure such as fat transfer with possibly some microliposuction to reduce malar bulging is a good option, and not another midface lift. Good luck!

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews


is difficult to understand without photographs, but quite often asymmetries to the shape of the mid face can be addressed with fat grafting and to talk to your surgeon about these options. I agree additional invasive surgeries are more difficult in secondary cases.

Good luck!

Mark T. Boschert, MD
Saint Louis Plastic Surgeon
4.9 out of 5 stars 30 reviews

Is there a way to re- suspend the malar tissue which doesn't involve either transconjunctival or intraoral incisions?

Thank you for your question. It is best to be seen in person. Schedule a consultation with a board certified plastic surgeon to discuss your previous surgery and your options going forward.

All the best,

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 458 reviews

Midface lift

Truly difficult to answer without images. However, It is possible that a traditional face lift with potentially a well designed SMAS flap and good redraping of tissues might be the best approach- Iwould advise against additional mid face only apraoches.

Ludwig A. Allegra, MD
Seattle Facial Plastic Surgeon
4.0 out of 5 stars 16 reviews

Be wary of the midface facelift.

This approach to restoration of youth to the face is very precarious. There is a high complication rate. More traditional facelift approaches are probably safer and more thorough in elevating the midface a malar fat, repositioning it, and supporting it.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Midface lift

The lift can also be done via a facelift incision.  This would avoid an intraoral or a lower lid approach.  However there is always a risk to the infraorbital nerves since the dissection needs to be done around the nerve.  Could you provide photos so we could better understand your situation?

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Need photos

Hi.  It is very difficult to appreciate your exact problem without photos.  Form the sounds of it you are worried about too much prominence of the malar so I am not sure a redo midface lift would be appropriate.  A combination of liposuction and fat injection may improve things with minimal downsides.  A temporary filler can be used to simulate results from surgery.  If you do need a midface lift I would suggest a hidden scar in the hairline and dissection under the skin which has the lowest rate of nerve injury.  PS the numbness should continue to improve up until the 2 year mark.  Hope this helps.

Correcting over-corrected mid-face lift

Thank you for asking about your mid-face lift.

  • I am so sorry you had problems with your mid-face lift.
  • You are correct - re-operating in the same area will cause more swelling and might cause more nerve damage.
  • And you are correct - a transconjunctival approach does risk lower lid changes.
  • Other forms of suspension can also damage nerves - directly or by traction (pull on the nerves).
  • It isn't clear if the malar bulging is from over-correction -
  • If so, suspending it higher will make things worse - the correction would need to be taken down.
  • This can be a challenge.
  • It is best to get a second opinion in person, taking along before/after photos and a copy of the operative report.
Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Is there a way to re-suspend the malar tissue which doesn't involve either transconjunctival or intraoral incisions?

There are other options depending on your anatomy and degree of skin laxity. The simplest and least risky as far as nerve injury would be a subcutaneous suspension either through a traditional facelift type incision or a percutaneous approach. Fat grafting or fillers may be an option, but again, it depends on your present anatomy.

Don W. Griffin, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 72 reviews

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.