Mid facelift through the lower lid vs. temples: which is superior? And why?

Question

There are two approaches to a mid facelift: trough the temples and the lower lid. Which approach is more effective for patients who have a negative vector?

Yannis Alexandrides, MD, FACS · Answer

This is a very complicated area of the face and different plastic surgeons have different techniques in order to improve it.  As you mentioned, there are techniques through the lower eyelid, however, a lot of those end up in complications such as ectropion. Then, there are also the techniques carried through the temporal area.  These methods sometimes are not so effective and can create alopecia around the temples.  There are techniques such as the extended SMAS or high SMAS. The combination of lifting with fat injection can as well improve a negative vector.

Alan Gonzalez, MD, FACS · Answer

Hello dear @Linasjourney, thank you for your question. The approach depends on the technique and the result to be achieved. That is why it is important that at the time of making your surgical plan all the factors that can generate the desired result are taken into account. Best regards! Alan Gonzalez MD, FACS.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. A personal evaluation is best to determine the appropriate surgical approach. It will depend on your skin, facial profile, the severity of issues, your goals, and the surgeon’s skills and techniques. I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon. During your consultation, your surgeon can perform a proper evaluation, recommend the best approach, and ensure the best possible outcome.

Ronald J. Edelson, MD · Answer

I never bought into the nonsense of negative vectors. I don’t even know what it’s supposed to mean. I’m also not a fan of midface lifts. They do remarkably little and I’ve seen some bad problems with the lower eyelid dragging down

Naveed Ahmad Khan, MBBS · Answer

The choice of approach for a mid facelift would depend on the specific needs of the patient and the surgeon's preference and expertise. However, in general, the approach through the lower eyelid may be more effective for patients with a negative vector.
A negative vector refers to a drooping or sagging of the tissues in the midface that creates a downward slope from the cheekbone to the nose. This can result in a tired or aged appearance. To correct this, the surgeon would need to lift and reposition the tissues in the midface.
An endoscopic mid facelift through the lower eyelid approach allows the surgeon to access and lift the tissues in the midface, repositioning them to a more youthful position. This approach also has the added benefit of addressing any undereye bags or sagginess, which can contribute to a tired appearance.
That being said, both the temple and lower eyelid approaches have their benefits and limitations, and the choice of approach would depend on the individual patient's needs and the surgeon's expertise. It's important to consult with a board-certified plastic surgeon who can assess your individual needs and recommend the best approach for you.

Gilbert Lee, MD · Answer

Thank you for your questions. It is impossible to tell which approach would be best for you without photos. In general, a mid facelift through the lower lid will bring volume into the lower lid and can be beneficial for a patient with a negative vector. I recommend scheduling a consultation with a board certified Plastic Surgeon who can assess your anatomy and develop a plan that meets your goals. In our office we offer 3D imaging to give our patients an accurate idea of what their final result will look like. Good luck!

Patrick Flaharty, MD FAACS · Answer

The right answer is that both approaches can be used successfully to lift the midface and it really depends on the preference of the individual surgeon. If you have a true negative vector based on deficiency of the cheek bone then a cheek implant, fillers, or fat augmentation may be considered to correct this deficiency. Fillers can be a nice way to assess the effect of volume in the cheek in a temporary and reversible way. Once you determine the volume correction you desire then you can move forward with something more permanent such as a cheek implant or fat augmentation, or just continue with longer lasting fillers which typically last a year or longer and are easy to adjust to your preferred shape over time. Midface lifts without adding volume do not correct a negative vector.

Elcin Ariturk, MD · Answer

This actually depends on the patient's complaints and what approach the doctor is comfortable with, but if the goal is to provide a lift to the temporal region in the middle face, of course, the lower lid will not benefit much from the approach.

Gerald Wittenberg, MSc, DMD (retired) · Answer

The 'vector' of the lift is the critical factor. Without images, one can only say that the lower lid approach done properly 'raises' the tissue directly to the area of concern; whereas the temple approach accentuates the area near the 'corner' of the eye/cheek. The surgeon must not remove any tissue in both circumstances.

Mid facelift through the lower lid vs. temples: which is superior? And why?

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