Will the eye shape be changed with a Midface lift (MFL) performed from incision under the eyes?

Question

I have been suggested a MFL with incision under the eye as it is felt i now have excess skin which needs to be excised hence endoscopic not being an option. I assume as excess skin cannot be excised. Can this change the shape of the lower eyes by dragging skin down even many years later if not soon after?

Sam Speron, MD, FACS · Answer

A Mini Facelift can usually be an option on most realistic patients anytime after the age of 35-40. It really depends on your anatomy and genetics. It is best to talk to your surgeon because everybody has different techniques and recovery time is usually based on a number of factors. 
I strongly feel that it's very important to have an honest conversation with your surgeon about your particular situation, lifestyle, work environment and specifically which procedures you're having done so that you both have the most honest answer about your recovery and are realistic with expectations and results.
Surgery is not for everyone. In today's day and age, there are many nonsurgical options to consider although surgery usually gets the most improvement specifically of the jowls.
I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of facelifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations. 
I hope this helps and wish you all the best in your surgery and event. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Thomas A. Mustoe, MD, FACS · Answer

There are different approaches to a midface lift and each has their trade offs.  Lifitkng the midface through an eyelid incision has been associated with a high complication rate of changing eyelid shape.   The lower eyelid is a delicate structure supported by a very thin weak muscle (orbicularis).   The cheek is much bigger and heavier and a lot of surgical dissection is required to erase it and move it.   Although the fixation is not directly to the eyelid, the forces of healing are strong and any slight variance can result in forces on the eyelid that change shape.   The eyelid is support d with sutures to counteract these forces but in practice there has been a  significant risk of over or under correction.  In choosing your surgeon I would look at lots of before  and after pictures of that surgeons work as well as looking at credentials reputation and reviews.

James M. Economides, MD, FACS · Answer

The midface lift approach is a good option for those who have simple descent of the midface and in particular the malar fat pad.  When skin resection is necessary, this may need to be carried to the undereye.  When this is done, it may alter the appearance of the lower lid (however, perhaps not in a bad way).  I would look at before and afters from your surgeon to get a sense of what is achievable with this technique.

Ben Lee, MD · Answer

The transblepharoplasty incision midfacelift sounds like an elegant approach. And it is. You really can technically lift the midfacial tissues through this minimalist approach. However, just because you can doesn't mean that you should do it all the time. The procedure is know for a high rate of complications even in the best of hands. These include eyelid complications, as you have mentioned, as well as the fact that you are pulling the thicker cheek skin onto an area that requires very thin skin. There are other, lesser invasive methods to achieve a mid facelift, and you should consult with a competent and experience facelift surgeon. I have performed a midfacelift as you describe, but usually to achieve a mild improvement in appearance when I'm already doing a lower blepharoplasty.

Christine Rodgers, MD · Answer

HI Amber, It depends on the surgeon and their familiarity with the procedure. I will say that I have seen some fairly scary photos at meetings with type of technique and I personally would not perform a facelift that way. I do not think that you can get an adequate neck lift at all if you try to do a full facelift this way.Best,Dr. Christine Rodgers

Kenneth Hughes, MD · Answer

Hello, thank you for your question. There is not just one facelift procedure, but a whole range of facelift procedures. These different techniques have been developed over the years, involving different incisions and lifting the skin to varying degrees. A facelift may also involve the tightening of certain muscles and tissues, or liposuction of areas such as the jowls or chin. It is important to choose a highly skilled and experienced certified plastic surgeon to match your goals and skin type with the appropriate surgical techniques.

Robert M. Tornambe, MD · Answer

AmberI appreciate your concerns, however photographs would be needed to provide a more detailed answer. Another option you may consider is mini facelift.My favorite technique is the MACS short scar Mini-Facelift. Developed in Europe, it is the ideal approach for the younger patient, not ready for a full facelift, or patients who desire a less invasive procedure with a shorter recovery time. It addresses both the mid face area (especially the jowls) as well as the neck, if needed. Consult with a board-certified plastic surgeon in your area to explore the best options for you.  Good luck.

Roger J. Friedman, MD · Answer

If as you say you have excess skin currently under your eyes, a midface will only contribute more skin to your lower lids as it is a vertical lift. The cheek can be elevated with endoscopic dissection or under direct visualization. The skin is remove through an incision under your lashline. There may be some early changes in the shape of the eye as the lid is often tightened as a component of this procedure. This typically resolves over 6-8 weeks.

Karan Chopra, MD · Answer

The midface lift via eyelid approach will reposition sagging fat pads to an improved position. Excess skin cannot realistically be addressed but you may not need much skin removed. If you did, then a proper facelift is a better alternative. 
Eyelid complications such as an everted lower lid (aka ectropion) can occur through the eyelid approach even in the best of hands.

Douglas McGeorge, FRCS(Plast) · Answer

Mid-face lifting can be done without changing the shape of the lower eyelid.  In the procedure the deeper tissues are fixed to the bone, reducing tension on the skin and lessening the risk of pulling on the lid.If you have concerns, I would suggest considering a second opinion, from a member of the British Association of Aesthetic Plastic Surgeons, who carries out mid-face procedures.

Will the eye shape be changed with a Midface lift (MFL) performed from incision under the eyes?

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