Mid FaceLift - I want to address under eye hollowness & sag lines under cheeks, what are the possible technique options? (photo)

I seek to address (1) hollowness under the eye, (2) “sag” lines under the cheek bone. To be perfumed with a lower blephoroplasty and lower facelift. (A) Is there any point considering an endoscopic approach (given multiple procedures). Could results be as durable as a more invasive technique? (B) Aside from repositioning of malar fat pads what other tissues might be repositioned. How does this affect the risks and results? (C) How do the terms such as “SMAS” and “Deep Plane” to the mid facelift?

Doctor Answers 6

Improve cheeks and eyes

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Thank you for your face lift question. A lot depends on money available and time for recovery.
  • First, a full examination and discussion is needed to come up with your best plan,
  • The photo doesn't show your lower face so I cannot comment on the need for a lower face lift
  • You have mid-face descent of tissues - as almost every Caucasian does by their 40s.
  • If you have surgery, a mid-face lift - by which I mean an open approach to the lower lids to release the arcus marginalis of the inner eye, reposition the eyelid fat, suspend the eye with a canthopexy and lift the cheek tissue to secure it to bone - would give your best result. This will address hollow eyes and cheek sag.
  • Endoscopic surgery can be used, but it is harder to get a good permanent result.
  • The SMAS and Deep place face lift apply to the lower face lift. The mid-face lift is below the SMAS.
  • If the risks, cost and recovery of surgery are not for you - then Voluma or other filler, is a very good alternative. It is not permanent and it also has risks and you will end up spending as much as on a face lift over time. 
  • The risks for any treatment around the eye of any kind always includes the very rare risk of damage to vision but the common ones are lumpiness, bruising and insufficient improvement with fillers
  • And for any surgery are bleeding, infection, poor scars, poor healing, a disappointing result, nerve damage and the need for additional surgery - although in elective, carefully performed surgery, most complications are minor and resolve in 6 weeks. Hope this helps. Best wishes.

Apparently good candidate for fillers not a midface lift.

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I would proceed carefully before considering a midface lift. From the photographs it looks fillers might be indicated. If considering lower eyelid surgery the orbital fat can be reposition to correct the tear trough abnormality.

Tear trough hollowness and mid face sag

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There are several ways in which you can address hollowness under the eyes. The methods include re-draping the fat from your own lower eyelid fat bags over the bone of the lower orbit to fill in the tear trough. This obviously only works if you have enough of your own lower eyelid fat bags to sufficiently fill this area.

If you do not have lower eyelid bags it is almost always possible to get some fat from the central upper eyelid fat compartment and this can be placed in a pocket in this area to at least partially fill the tear trough hollow. Another technique that works really well is to suction fat from the abdomen, "micronise" this fat into very small fat droplets and inject these very fine fat droplets into this area. This can be combined if desired with tightening of the lower eyelid muscle (the orbicularis) to efface this area.

(A) There is no point considering endoscopic procedures as they simply do not work and cause more trouble than good.

(B & C) For the hollowness under the eye area the SMAS and Deep Plane facelifts are generally irrelevant in improving your specific concerns. Well performed lower eyelid surgery with either fat bag repositioning or fat injection is far more likely to address your concerns. Both SMAS and Deep Plane facelifts can bring limited improvement to the sag lines under the cheekbone you refer to but these are almost always combined with injectable fat transfer to this area in people with these sag lines.

Facial Rejuvenation

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Your areas of concern are common requests from patients.  There are several options to improve the under eye hollowness and face.  However, men's faces and goals are very different from that of women.  Options include nonsurgical, minimally invasive, and surgical technique to address these areas including the newest technology.  Please consult with a board certified specialist in the face who can assist you with achieving the results you seek.  3-dimensional computer imaging will also help you visualize what you may look like afterwards and serve as an important tool to communicate with your surgeon.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Mid FaceLift - I want to address under eye hollowness & sag lines under cheeks, what are the possible technique options?

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Yes, men do want to appear less tired looking.  Having a bit of filler with a mini-incision type facelift will remove
7-12 years from your appearance!  The recovery is quick and easy.   

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Start with dermal fillers and injections before a mid face lift for Hollow eyes and tear trough deformity

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Thank you for your question.  You appear to be young and your photograph and before undergoing major facial surgery I would suggest that you consult an expert board certified plastic surgeon who is skilled at dermal filler injections.

Your cheek can be volumize nicely and the tear trough area improved with filler injections.  An expert can also use a small amount 0.6 cc of Restylane to carefully plump the nasojugal fold that small depression beneath your lower eyelid near the nose.

An expert can certainly improve the areas your concerned about without having to undergo major surgery which will have to include open fat grafting into the lower eyelid area.

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.