Vertical mid face lift; Why do a lot of patients look like they have a longer face after having this procedure?

Thank you for the question. I think there is a key distinction to be made between a midface lift, which is typically done through an endoscopic browlift-type approach (or less commonly, through a lower eyelid approach) and a facelift technique that emphasizes lifting the midface tissues (e.g., deep plane facelift or high-lateral SMAS). The former can have some negative consequences for the fatty tissues around the orbit and in the lateral face; in addition, it gives a more limited change. The latter are perfectly good options for lifting the face, especially in cases where the fat pads and soft tissue of the cheeks has dropped significantly. The vertical vector is described to emphasize that the tissues are lifted MOSTLY in a vertical direction. It is not straight up, but more up and back (toward the temples). When done correctly, this should reposition the fat pads to their more youthful position -- without changing the face shape.

Generally the midface tissue is lifted to the temple area.  This causes a variety of aesthetic issues.  The worst of these is a subtle break down of the fat along the orbital rim.  This loss of this volume creates a hollowing along the zygomatic arch.  This has a profound negative effect.  This little cushion of fat along the orbital rim aesthetically isolated the eyes from the temple.  Without that cushion the gaze drifts off the eye area and into the temple.  Patients with this deformity report that people no longer look in their eyes.  I have several methods for correcting this issue.