Midface lift/lower bleph/forehead lift affect eye shape (surgery by Facial plastic surgeon fellow)

I'm concerned about the controversial midface lift. I want the nasal folds gone.. Cheeks slightly lifted. Very very conservative.. But now thinking fat transfer? I'm 49 but 5'7 117 lbs and muscular. I don't know that I have too much fat to transfer! I don't think I want the upkeep of fillers. Surgery to be performed by former AAFPRF president 's fellow. Thoughts? Suggestions?

Doctor Answers 7

Midface lift

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In the first picture your brows look high, so not sure you would want them any higher.  You also have a lot of heaviness in the jowls and lower face.  A midface lift will help with these, but remember that you will always have some NLF.  Fillers over the cheeks, or fat if you have any, would help with the NLF and also give a better shape to the face.       

Fellow Plastic Surgery

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If you're from Rochester, you are probably referring to Dr. Vito Quatela's fellow... I was also his fellowship many moons ago. This is a first rate fellowship, I'm sure the fellow is well trained. However, you have to do your homework and feel good about your choice. I'm sure if Dr. Quatela feels confident , you should be fine.



Surgical outcomes are almost entirely dependent on the choice of surgeon.

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Inside the profession it's generally known that surgical outcomes are almost entirely determined by your choice of surgeon. The choice of technique an ancillary treatments are judgment calls that should be made by your surgeon you trust.

Midface lift/lower bleph/forehead lift affect eye shape (surgery by Facial plastic surgeon fellow)

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In most cases it is plastic surgeon's would like the swelling and firmness under the skin to resolve before any revisions. This could take at least 4 to 6 months.The overall result will be better if you can allow some time to pass before any revision surgery. Also the extent of surgery may not have been sufficient to correct the degree of skin excess in the first place.

Good Luck to you

Aging transition from injectibles to surgery; Mid-Facelift, Brows, Eyelids, Cheeks and Jowls

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Dear AvaL:

Thanks for sharing your photos! You do not look your age. 

It is best for you to obtain a proper exam and recommendations from a seasoned Board Certified Plastic Surgeon or Facial ENT Surgeon with years of experience. 

You're 49 and unfortunately, the effects of aging start to accelerate.
  1. Fillers and Botox while available and "easy" are not necessarily well done and are only one option (which you don't wish to keep-up). 
  2. At 5'7, 117 pounds and muscular, you may not have enough fat to harvest on several occasions for fat grafting as fat is unreliable to survive 100% with each transfer.
  3. I love mid face lifts in properly selected patients. It is an option but creates much more vertical lift  with better improvement in the nasolabial folds but not as much lift in the corner of the lips and jowls than a facelift. Based on the rounding of your lower eyelids in the first photo, I would be cautious with a mid-facelift due to the potential pull-down on your eyelids during healing. 
  4. You may like a short scar facelift as a better longer term option. 
  5. Upper and lower lid blepharoplasty may be considered too. 

All the best with this!

Assessing surgical plan

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Thank you for asking about your face lift, blepharoplasty and forehead lift.

  • You have a lovely face and will do well with surgery.
  • You can combine fat transfers with your facial surgery.
  • The nasal folds can be softened but may not be completely gone -
  • They are a normal feature on many faces even in the teens.
  • If you have found a surgeon you trust, trust his/her recommendations.

Always see a Board Certified Plastic Surgeon
Hope you found this answer helpful. Best wishes.


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Your photos some cheek descent with some NL folds and small marionette lines. I agree that filler/fat alone will correct partially,but it is simpler.Surgical options seem sound to address mid face. Your forehead could well be left alone. Your brow looks nice.Good luck.

William C. Rigano, MD
Dayton Plastic Surgeon

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.