Is a Lower Bleph Usually Done with a Mid-face Lift?

I had a consult with two surgeons.

Two facial surgeons have recommended lower facelift, mid facelift and brow lift. One insist that the lower eyelid has to be done in that combination because of the excess skin being pulled up and doesn't do mid face and brow lift w/o lower eyes. The other says the lower lids not necessary in that combination. I had lower lids done over 20 years ago and they aren't real bad. Does anyone have opinion on this situation?

Doctor Answers 18

Is a Lower Bleph Usually Done with a Mid-face Lift?

 The goal of any plastic & cosmetic surgery should be to make one more naturally attractive.  How the surgeon accomplishes this goal can and does vary with every surgeon.  Understanding that allows the prospective patient to concentrate on what is the "end result" how is the face going to be made to look more youthful and naturally attractive instead on the mechanics.  With Face Lifts, IMHO, it's imperative to create more aesthetically attractive cheeks as well as removing excess skin to accomplish the desired effect.  

Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Lower eyelids and Midface often worked on together

The lower eyelids & cheeks are 2 facial areas that are often worked upon independently or together, to achieve a great rejuvenation.  It really just depends on your anatomy AND your goals. 

Undoubtedly, there are many options for the these 2 cosmetic units: under eye skin pinch excision, fat bag removal, under eye peel, midface lift, cheek lift, fat transfer, and malar implants among the most common.   Any of these listed can also be performed with a facelift or brow lift for an ideal result.  The Bottom Line: if you've already had your lower eyelids done 20 years ago, you are probably a great candidate for simply a skin pinch and a peel to "freshen" up the lower lids at the same time you're having your brow lift / midface lift. Ask both surgeons about this, and good luck!  

Randolph Capone, MD, FACS
Baltimore Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

Yes, Lower Bleph and Mid-facelifts are commonly combined, but There are Exceptions.

Hi 1554anon,


You stated the reason why mid-facelifts and lower eyelid surgery are often performed together, because of the potential for the lower eyelid skin bunching and causing more wrinkles under the eyes than prior to the mid-facelift.  


Just because they are often performed together for good reason, ultimately each person's face is different and their past surgical history is also different.  If a surgeon follows a cookie cutter approach to all faces, then there is a risk of performing unnecessary surgery and with each additional surgery additional risks apply.


If you smile, it is similar to a mid-facelift.  When people smile the cheek rises and the lower eyelid skin can bunch and wrinkle.  Not all mid-facelifts performed by different surgeons are equivalent.  You are not buying a shirt at one GAP store, which would be the same at another GAP store.  Instead each plastic surgeon is like a contractor.  Depending on which one you choose, you can get very different results.


Some patients who have had bad lower eyelid surgery with ectropion, or lower eyelid malposition already have had too much lower eyelid skin removed.  Some reconstructive eyelid plastic surgeons will perform a mid-facelift alone to help push the lower eyelid upwards to improve the post lower eyelid complications.  I have seen one patient who had a lower eyelid and mid-facelift combination have a problem when she opens her mouth, the lower eyelid pulls away from her eyeball.  When she doesn't have any facial expression, it looks fine, but obviously this is not natural, and for this patient the cosmetic improvement was not worth this post-operative problem.


If the mid-facelift is performed conservatively, and taking into consideration the fact you already had a lower eyelid surgery in the past, I can see why one of the surgeons did not recommend it.  


In general, I am not a big fan of the mid-facelift procedure and prefer volume restoration of the transition area of the lower eyelid and upper cheek using either fat grafting or fillers, depending on the patient's age and facial aging issues, and preference for surgical versus non-surgical improvement.


I am also not a fan of aggressive browlifts either.  I wrote an online article titled, "To Browlift or Not to Browlift that is the Question" explaining my thought process.


Be careful, do your research, and good luck on your plastic surgery journey!




Dr. Yang

George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

A Lower Blepharoplasty Is Done With a Midface Lift If It Needs To Be

As with many situations in facial plastic surgery there is not one answer that applies to all situations. The issue here is that when the tissues of the mid face are lifted upwards they tend to push the lower eyelid skin towards the lid margin, causing some wrinkling of the lower lid skin. Whether or not you need a lower lid blepharoplasty with your mid face lift depends on how much wrinkling of the lower eyelid skin you get. If you have had your lower lids done before, you may not get enough wrinkling of the lower lid skin for this to be an issue. Sometimes though, even if you don't seem to have much lower lid skin present prior to the surgery, you get enough mid face elevation with the lift that you end up with enough lower lid wrinkling that you will need to have the extra lower lid skin removed in order to get a result you like. My personal preference is usually to make the judgement at the time of surgery. After the mid face lift is done, I will reassess the lower lid skin to see if it needs to be addressed. The key, remember, is to get the results you desire. We don't want to do surgery that doesn't need to be done, but also want to make sure that after having the amount of surgery you are talking about, that you are not unhappy with the results because of remaining wrinkles under the eyes. I hope this helps. Good luck. 

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 26 reviews

Mid facelift and lower eyelid surgery

The issue with mid-face lifts and lower blepharoplasty is that at surgery the cheek lifting can cause some bunching of lower eyelid skin. The surgeon then removes this skin. The problem is the patient is lying down not standing and some of the cheek lifting is also lost after surgery. The end result then is too much lower eyelid skin was removed at surgery. You have to be very conservative with this type of surgical combination to avoid future problems. Without photos or a face to face examination it is impossible to say what would best in your case.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Lower and midfacial surgery surely will need lower bleph correction but uncomplete/si ya has sido operada de parpados infs

if you have been operated on years ago of lower bleph, and you are  going to get  a mid, lower and upper lifting  you  surely will need  an uncomplete  lower  bleph correcting  only skin and muscles  without touching the palpebral fat sacs.

si tu ya has sido operada previamente de los parpados infs y te vas a someter a una riti medial, inferior y superior seguramente vas a requerir tocar los parpados infs, pero en forma incompleta es  decir  solo tocarias la piel y el musculo pero no las bolsas  palpebrales

Ramon Navarro, MD
Mexico Plastic Surgeon
5.0 out of 5 stars 2 reviews

Lowwer blepharoplasty and mid face lift

I am not a big fan of mid face lifts alone.  I usually elevate the cheek from a full facelift.  The midface lift has a significant complication rate in many studies.  One problem is when too much skin is removed from the lower lid.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Midface Life is Not Always Necessary

There has been a trend moving away from midface lifting towards more conservative (and therefore, more safe) lower eyelid surgery.  While some limited fat and skin removal may be required (not always), many physicians are relying on resurfacing (e.g. fractionated resurfacing lasers) and fillers (e.g. hyaluronic acid fillers such as Juvederm and  Restylane, or fat injections) either with or without surgery.  In my experience, and seemingly the experience of many other facial surgeons that I greatly respect, the risks of particularly aggressive midface lifst do not predictably match up to the rewards.   

John Frodel, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Facial cosmetic surgery is customized to patient needs

There is no usual in facial rejuvenation surgery. Every case is unique and based on the patient's needs and concerns. Photos would certainly be helpful. I also agree with others that there is a difference between a little "nip/tuck" in the lower lids and a full blepharoplasty so you may want to get a clarification on this point. Good luck!

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Is a Lower Bleph Usually Done with a Mid-face Lift?

Each cosmetic procedure in my practice is customized for the individual patient. Without seeing your face, it is impossible to give any opinion.

Kenneth A. Marshall, MD, FACS
Wellesley Plastic Surgeon
4.3 out of 5 stars 8 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.