Is the vertical midface lift, (subperiosteal) still a useful procedure?

Question

I'm 40 and have been told I could benefit from a midface liftperformed through lower eyelid to fix undereye hollows and slipped down cheek pads. I have heard some controversy on the mid facelift performed through lower eyelid. Is this still a popular procedure or are the better options? Thank you!

David Gilpin, MD · Answer

Thank you for your question.  A midface lift performed through a lower eyelid incision is a safe and reasonable procedure, when performed by someone who has quite a bit of experience with this procedure.  That being said, there are other methods to performing a midface lift.  Most times a midfacial lift is performed along with a deep plane facelift. This procedure allows access to the face, midface, and neck.  A midface lift can also be performed as a stand alone procedure through an endoscopic approach from incisions made within the hairline.  I would consult with a board certified facial plastic or plastic surgeon, who specializes in facelifts and midface lifts.  Be sure to ask for before and after photos, to be sure they are in line with the goals you have for surgery.  I hope that this helps!-David Gilpin

Thomas A. Pane, MD · Answer

This procedure is not recommended in most cases.  Although it was once popularized, most experienced face lift surgeons tend to agree that more aggressive procedures such as this will reliably increase complications without reliably improving results.  I favor a face lift with suture treatment of the SMAS and fat grafting as appropriate.  Going deep risks serious and permanent complications for no demonstrable improvement in outcome.  I think you are reasonably well informed already, and I hope this and other answers will help you make an informed decision.

Ronald Schuster, MD · Answer

This is still a very good procedure but needs to be performed by experienced surgeons. This is my preferred route for midface lifts. If it is not performed well however it can cause some problems with the lower eyelid.

Stephen Prendiville, MD · Answer

The short answer to your question is that this is a procedure that has some relevance, but is not a substitution for a SMAS based facelift.  Because on this fact, it is a procedure that is less commonly employed than 15-20 years ago.  As others have noted, it carries a higher degree of risk than other "lifting" techniques so it should only be used in very specific circumstances.

John Michael Thomassen, MD · Answer

This procedure has been associated with some complications, including lower lid lag and ectropion.  A safer approach would be a SMAS facelift with a lower lid blepharoplasty.

Arthur Dean Jabs, MD, PhD, FACS · Answer

Whenever you see several ways to do a procedure it is usually because there is not one way that is substantially better than the others. A mid face lift through an extended lower lid incision is a procedure with little to no room for error. The lower eyelid must be supported, in my opinion, with a canthopexy to help prevent compications because of the amount of tissue that is recruited with the lift. Be sure to discuss with your doctor before proceeding. 
Best of Luck
Dr. J

Earl Stephenson, Jr., MD, DDS, MBA · Answer

In my opinion this is a useful procedure in the right person.  There is alway concern about the periorbital aesthetics during this procedure.  A simultaneous lower blepharoplasty and canthoplasty usual performed to improve the lower lid aesthetics and help with maintenance of the results.

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. It would be helpful to see photos of your face. Endoscopic midface lifting is not a substitute for a conventional facelift procedure as the neck and temples are not improved by this limited procedure. It accomplishes a lift of the cheek region creating a higher and more well-defined cheekbone. I suggest that you move forward and consult with a board certified facial plastic surgeon.
Best wishes,

Audrey A. Klenke, MD, FACS · Answer

Every plastic surgeon has been trained differently and makes different recommendations based on her or his experience. A subperiosteal mid-face lift is a procedure that is still performed, but there are other options as well depending on your exact problem. At 40 years old, you may not need surgery yet. There are non-surgical options like using fillers to help replace lost volume in the face including the tear trough or under eye area. I would suggest meeting with a board-certified plastic surgeon to discuss your concerns and seeing what options are out there for you. Good luck!

Steven Wallach, MD · Answer

Some surgeons do perform a mid facelift. I prefer to do it through a facelift incision and combine it with fat grafting as needed. Best of luck.

Is the vertical midface lift, (subperiosteal) still a useful procedure?

Answers (18)

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