What is the Best Procedure to Lift the Midface?

I am considering a midface lift and would like to know which is the best & longest lasting procedure. A midface lift with endotine or a Soof lift. I would like to improve the nasal folds & feel my cheeks have become flat and sag. I have a bit of hollowness under my eyes. I would like to improve what I have been told is the "golden triangle". I also heard that a midface lift with endotine gives very little improvement and may only last a year. I had a facelift & it did not improve this area.

Doctor Answers 23

Midface surgery simplified

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As the originator of the SOOF lift blepharoplasty I can tell you that in my opinion this is the best procedure for improving the hollow look under the eyes that accompanies the aging process. I've been doing nothing but this procedure since I originally published this approach around 1999 in the Archives of Facial Plastic. As far as improving the nasolabial fold a SOOF lift by itself will help minimally. Most of my patients that have midface laxity have laxity elsewhere and have a deep plane minituck or facelift. I would recommend you avoid endotine lifts in the midface and/or "thread lifts" as in my experience neither is very helpful in the long run. To lift the midface solely a malar pad lift is done in my office with good results. It can be done under local. Occasionally a cheek implant is also helpful depending on the patient and pertinent anatomy. Seek a facial specialist and get two to three opinions, look at the doctor’s photos and you'll do alright in most cases.

Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Best Mid Facelift Procedure? It Depends On Your Face

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Dear July4-


Your knowledge about mid facelift surgical options is impressive.  Endotine mid facelifts seem not to last as long as we initially thought, so more plastic surgeons are looking at a straight forward blepharoplasty, with possible fat grafting to the cheek areas.  


A "deep plane" facelift is an option, but increasingly, most plastic surgeons are doing "less" surgery, not more, in the area of the cheek.


Pulling on the cheek SMAS, the scaffolding or holding structure of the facial tissues, may help to lift up your mid face, assuming it was not done with your original facelift.  There are several options regarding this-  including tightening the SMAS, cutting the SMAS and then tightening it, or imbricating the SMAS.


So, seek out several opinions, but rest assured that your best result for your face should be possible with a plan that is individualized for your face.


Best Wishes,

Roy Kim, MD

Roy Kim, MD
San Francisco Plastic Surgeon

Best procedure to lift the midface

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A set of photos would really help to provide you with the best advice. In general, the results of a full facelift can last up to ten years before any touch ups are necessary, and it is the most effective procedure.  A full facelift addresses the following areas:
1) neck 2) Jowls and 3) Midface. Each patient has different circumstances, and a thorough in-person evaluation will help determine the best procedure for you.

Depending on your needs and goals, a less invasive procedure may be adequate.  An example is a mini facelift, where the incision is shorter. A mini facelift has its benefits as well, such as less time in the operating room and a lower cost.

In listening to your concerns, I would also advise you to look into replacing the lost volume in your midface with fillers, fat transfer, etc.  Lifting sagging tissue without replacing lost volume can lead to an unnatural look.

I would recommend seeking the advice of a specialist who has a great deal of experience performing facelift surgery.  I hope this helps!


Restoring Volume to the Midface

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The midface in youth has volume and the cheeks are sometimes referred to as “apples”. As time goes by or after childbirth and weight loss, the midface area loses volume and becomes more flat. In the late 90′s, some surgeons interpreted this loss as a drooping of the midface and believed the area need to be lifted.The Midface or area of the cheek has been a controversial area in the field of cosmetic surgery. There are some surgeons who believe in lifting the mid face with an endoscopic midfacelift. As an Oculofacial cosmetic surgeon with over 15 years of experience, I routinely see patients who these surgeons have done this endoscopic mid-facelift procedure for, and they look overpulled and “cat like”. I believe in restoring volume to the midface with techniques such as fat transfer and placement of submalar implants or the Vampire Facelift using PRP (Platlet Rich Plasma) or PRFM (Platelet Rich Plasma Matrix). Restoring the midface volume at the time of facelifting makes a significant difference in how young you can look.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Best midface lift

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I just got back from Vancouver wher the biggest plastic surgery conventian was held. Mos experienced plastic surgeons have stopped doing mid facelifts and ar doing careful balanced fat injection.Dr. Paul in one of his lectures stated about 1/3 of mid facelifts need revisions.

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews

What is the Best Procedure to Lift the Midface?

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 In my aesthetic judgement, it's not lifting the midface but shaping it that should be the primary goal in any Face Lift or facial rejuvenation procedure.  The shape, of the midface = cheeks, has the aesthetic ability to make the face appear young, old, male, female, attractive or less so.  

 Naturall, more attractive and youthful faces all have aesthetically shaped cheeks.  A minimum incision Face Lift with proper cheek shaping using fillers like Perlane or Cheek Implants would accomplish this goal.  Be sure the plastic and cosmetic surgeon, you select, understands and follows the proper aesthetics of facial beauty for the creation of a naturally, more attractive face.  

 IMHO, fat transfer is not nearly as reliable as a stable, off the shelf filler or cheek implants and I have not used fat for facial augmentation for the past 20 years for that very reason.  

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

A Youthful Look in The Midface Can be Achieved With a Combination of Procedures

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Endotine midface lift procedures have questionable longevity and efficacy. A better midface lift can be achieved with volumization of the mid face area, laser skin tightening, and possibly blepharoplasty.  Most patients get excellent results with volumization and also skin tightening with external laser resurfacing without the need for eyelid surgery.  Fat grafting and the use of fillers are excellent procedures. Fat grafting may last longer than typical commercialized fillers.  By pursuing volumization procedures, one can optimize the cheek, tear trough, nasoabial fold, and cheek areas -- this would address all of your concerns.

Vish Banthia, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

Best mid face lift

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I do not like Endotine - have seen too many complications of other surgeon's work.

A standard face lift does not improve the area (as you discovered) but doing the extension of the MACS face lift - extending the facelift incision to lift the temple and apple of the cheeks - has given my patients beautiful results. This can be done separately after a face lift. A lateral brow lift may give you some additional lift, again safely and without distortion.

Above all, see a Board Certified Plastic Surgeon who can do all these techniques and discuss which is best for you and why.

Best of luck.

I think at best it is important to understand that mid face surgery is controversial.

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Midface surgery and midface concepts are relatively recent additions to the practice of cosmetic oculofacial plastic surgery.  As a pioneer of some these methods, generally mid face methods are great for medically necessary reconstructive surgery but not so great for primary cosmetic purposes.  For the most part, hyaluronic acid fillers for the mid face are a much safer, more predictable way of improving mid face ptosis.  There is no such thing as mid face cookie cutter surgery.  Each mid face deserves very careful evaluation in a personal consultation to determine which approach is right.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

The longest lasting midface lift

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The longest lasting midface lift or any facelift for that matter will depend on tissue to tissue healing to hold the shape. Suspension, such as threads or endotine hooks, may only hold as long as the sutures or tissue hooks will hang on. We like endotine in the forehead, however repositioning tissue along the fold and lid hollows (soof), and even fills (lipotransfer) are something worth considering.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

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.