Mid face lift or fillers? (Photo)

More information and an examination is needed, but usually, at your stage of life, descent of the five fat pads of the face, caused by weakening of the ligaments that hold them up, is the primary cause of a fallen mid-face.  Mid-face gravitational descent, not volume loss (which does occur) is most of the reason. This has been the conclusion of numerous articles and textbooks currently and over the years. It is not until much later in life, that severe volume loss occurs, though volume loss can contribute to gravitational descent.
 You seem to have orbitomalar, as well as zygomatic and MacGregor’s ligament weakening.  So your best bet is a sub-periosteal mid-face lift with either Endotine (done properly) or Gore-Tex fixation as we have published numerous times. 
Try smiling and see if your mid-face fallen volume is restored by the resultant induced melo-plication of your fat pads.  If so, a subperiosteal midface lift, done properly, should be helpful.
Nothing wrong with two or three vials of filler used every 3months to a year.  It will work for a period of time, but can, if overdone, give you a more “puffy” look.
A mid-face lift is often used as one of the tools to correct an ectropian, so should not cause one, unless a blepharoplasty is pulled upward.  Most often a mid-face lift is accomplished by a small incision in the temple, so does not pull the eyelid downward, but reinforces a proper eyelid position.
Your picture looks as if you have had some filler placed in the past (I might be wrong).  If so, you should inform your examining physician about this.
I’ve not mentioned another option, which is an “InstaLift” thread lift, which can also be done with a gore-Tex loop.  This can reposition the fat pads, but will not interrupt and re-position the ligaments.  The InstLift has a one year effect, and five years is common for the Gore-Tex suture loop lift.

I don't think a midface lift would be recommended for you.
I would start with a series of Sculptra injections to the right and left mid-cheek/malar area. This can be repeated every 4-6 weeks to get idea results.
Sculptra is not a filler per-se, but it will stimulate your own collagen over a period of time...and it will give you a very natural appearance. 

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.  See the below link on some suggestions on finding the most qualified Plastic Surgeon for you.  Always insist on a board certified plastic surgeon.

You have some anterior cheek and mid face issues with malar bags. A mid facelift through the lower lid incision can be helpful but caries some risk. Fillers like Resylane Lyft, Radiesse, or Voluma are very useful if done properly. I would stay away from any energy base procedure like the RFs and Ultherapy as they may melt additional soft tissue and make the matters worse.

To be honest with you I am not a fan of either fillers or the midface lift.  I think you need to be more specific regarding what you want to achieve so you will avoid disappointment in the future.

Thank you for your question and for sharing your photos . It is difficult to assess to what degree a 
mid-face lift will benefit you without physically assessing but from your photos you do not seem to need a facelift, fillers might be the best option. make sure you discuss your options with a board certified Plastic Surgeon.
Good luck 
Güncel Öztürk MD

You do not yet have enough sagging to justify a facelift. Concentrate on preventing sun damage by protecting your skin with sunscreen, hats and clothing. Have your dermatologist recommend a medical-grade skin care regimen with retinol and hyaluronic acid. Get regular chemical peels. If you do start to see some jowling, a mini lift, with or without a neck lift would give improvement. I hope this helps.

I would recommend volume enhancement using a number of techniques ranging from fat to synthetic fillers which can also be used under the eyes. Once facial aging progresses to skin laxity and dissent, I recommend a micro or many facelift. I actually have found that patients who get treated surgically sooner end up looking better longer.
Sincerely, 
Philip J. Miller, MD, FACS
Double Board Certified Facial Plastic Surgeon

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, I would recommend fillers such as voluma.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Hi TBD.  In most cases, the key issue in determining whether to suggest dermal fillers or surgery is volume loss vs. skin laxity.  If the skin is loose and drooping, then surgery is often the best option.  If the skin is taught and firm, but the patient is thin or has volume loss, then we suggest dermal fillers.  In your case it appears that you have not lost much elasticity in the skin but do have a depression in what's called the malar area.  We commonly use Radiesse and Restylane Lyft with nice results for improving volume.