Where is a Mini or Midface Lift Anchored? Is the Tissue Sutured Under the Eyes or Near the Ears? A Surgeon Once Warned Me Away

I believe some background information is necessary so that you can better comprehend this answer. In general, a facelift (aka rhytidectomy) is a surgical procedure to treat sagging skin and soft tissue of the face and neck. Classically, this is performed through access incisions that are strategically placed to hide the resultant scars, so that underlying soft tissue can be elevated in a more youthful location, sustained with support sutures, and excess skin is then removed when necessary. Over the last 40 years, there have been at least as many variations of this procedure designed, in part, to treat the wide variations of aging and facial characteristics that makes us all unique. Variations of these operations have also been developed to attempt to improve longevity of the results, minimize scarring, and some to decrease downtime. 

A mini facelift (aka weekend lift, lunchtime facelift, rejuvenation lift, s-lift) is basically a face lift where incisions are placed around the ears and the skin undermining is usually minimized and the lift is often created by pulling on the skin and supporting the lift at the suture line. This is usually reserved for patients with only early signs of aging. It can sometimes be performed under local anesthetic and there is usually less downtime. When used on someone with more advanced signs of aging it will usually not produce a very long term result;months to a year. There are many variations of this facelift variation. 

A mid facelift also has many variations. Usually this implies that the central portion of the face is being tended to. This is used to correct the lower eyelid cheek interface. This operation can be performed through an extended lower eyelid incision or a variation of the preauricular (in front of ear) incisions or a combination of both. It is imperative that the underlying support soft tissue is anchored well or it can lead to unsightly cosmetic and functional lower eyelid problems.

Before entertaining any of these procedures, I highly recommend that you consult with a board certified plastic surgeon that has experience with these procedures.   

A midface lift is sometimes called a suspension cheek lift. This is because it is anchored above the cheeks, lateral to the eyes, in the temporal region. Specifically, it is most commonly anchored to the temporalis fascia.

Because this is some distance away from the eyes, if this procedure is done well, it rarely causes any pull on the lower eyelids. It may improve the position of the outer eyebrows by elevating them along with the cheeks - often this is a very nice added benefit rather than something you should be warned away from. The direction of pull on the cheeks is upward and outward and on the eyebrows is upward.

Midface lift implies lifting the midface or cheeks and this is probably what was meant that was anchored under the eyelids.  A minifacelift can mean anything but in general produces mini results.

Mini- and mid- facelifts are quite different. Mini facelifts achieve minimal results because very little is done and fixation - if any - is, well, mini. Patients love to hear about mini facelifts because it promises something for nothing, or at least for less. Who wants a big operation when a little one will do? But, would you have a painter do a mini paint job on your house or a mechanic do a mini service on your car? Thought not. Rant over!

Mid face lifts are directed towards the front of the face as well as the nasolabial folds, and usually involve dissection under the lining of the bone (periosteum). Access can be through an extended lower eyelid incision or through a brow lift. Fixation is usually to the dense fibrous sheath that covers the temporalis muscle on the side of the head.

You should not choose a particular operation like you were dining from a smorgasbord. A Board Certified Plastic Surgeon will evaluate you and determine what areas he or she can improve and what procedures are the most appropriate means of doing so. A mid facelift is not suitable for everybody, a mini facelift for nobody.

A midface lift is done in a variety of different ways and no single way is the absolutely correct way to do it.  If the mid cheek tissue is pulled in the direction of your temporal area (the area above the ears and behind the hairline) and the fixation sutures are placed in the temporal area and not under the eyelids, it should not affect the eyelids at all.  This is typically the way many surgeons approach the fixation of the midface.  

A “mini” or “mid-face” lift is a very nice procedure for the perfect candidate, and not all patients are good candidates for this.  When I perform “mini-rhytidectomy”, the procedure in no way pulls the lower eyelids down, so I’m unsure what your surgeon was referring to. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Lillyming, your question is an excellent one and asked at the right time. Your Plastic Surgeon definitely gave you sound advice when she warned you away from a procedure which anchors the cheek at or near the lower eyelid tissues. If you had'nt heeded this advice we would be discussing the complicated problem of repairing a distorted and scarred lower lid. Anchoring the cheek is usually necessary to improve the longevity of the lift. There are many ways to accomplish this without risking your vision and lower lids. One, if not the only, fixed structure on the face is the ear and is frequently and effectively used to anchor both facial and neck tissues to improve the longevity of lifting without using the skin as the anchor point of the lift.

Your question is most likely directed towards the midface or cheek lift procedure. This is a very technique sensitive operation that is done primarily through a lower eyelid incision and the key is fixation of the lifted tissues. Lower eyelid distortion is its most common problem and there are many ways and tissue points which surgeons achieve anchorage of the lifted tissues. My preferred location is a cranial suspension point, away from and well above the eye area. While it is a good operation for cheek or malar tissue sagging, patient selection is the key. It is an operation that has been over-utilized in the past and complications rates have been significant, but if well done with good fixation in the right patient it is a very effective midface rejuvenation operation. 

Many surgeons, myself included, are performing fewer and fewer midface lifts due to prolonged swelling and potential distortion of the eyes. In office filler treatments or fat transfer has largely replaced this approach. The cheek tissue can be anchored to the bone of the cheek or to the muscle and fascia in the temple. It should not pull on the eyelid. A mini lift is actually a minimally invasive facelift and different from a midface lift. Minilifts are performed to help treat jowls and laxity in the lower face. I hope this information is helpful.Stephen Weber MD, FACS

The terminology about facelifts is somewhat confusing. A facelift, including a mini-facelift, really concerns the lower face and neck. Some mini lifts really do very little to lift these areas. Others, like the MACS lift or Today's Facelift use many of the techniques of a mini facelift, but provide full correction and long lasting results. A mid facelift is a designation of a procedure done in the mid face to lift the central cheek and lower eye area. The first methods did cause pull on the eyes. However, the more modern procedures lift the mid cheek and lower eyelids safely with anchors lateral to or above the eyes. See a Plastic Surgeon with significant experience with these procedures to reduce any risks.