Where and how visible are midface lift scars without makeup and is under the eye incision the only method?

Question

I would like a second opinion. My surgeon has suggested a face lift for loose midface skin. He has suggested incision under the eye lashes only but i am concerned about people being able to see the scar and risk of eye drooping down. Would a lateral hairline incision not alone help or at least in addition to under eye incision.

Ajaya Kashyap, MD · Answer

Thank you for your question. The mid facelift that’s you have been suggested is through an extension of a lower Blepharoplasty incision. I do this frequently when a lower Blepharoplasty is also required. When you need just a mid facelift , an endoscopic mid facelift through a hidden incision in the temple is also an option. A regular facelift incision can also be used when you need lower face also to be lifted along with the mid face. Please discuss all the  options with your surgeon before making a decision.All the best!

Ben Lee, MD · Answer

Thank you for your question. Typically, under eye incisions are very difficult to see, even in individuals who say they don't scar well. It is the one location in the body that seems to heal with minimal scars, given enough time. A midface lift via this incision would therefore seem to be a very elegant way to lift the midfacial tissues. However, the procedure is known to have a high rate of lower lid retraction and change in eyelid shape, even in the best of hands. If this were a great operation, we would all be doing them, on pretty much every patient, as the incision would be well hidden and the recovery would be fairly quick. There are, however, occasions where some midfacial lifting with this incision can be of great benefit, such as an add-on during lower lid blepharoplasty  in the appropriate patient.

Zoran Potparic, MD · Answer

There are cheek lift procedures that can be done through lower eyelid incision. This is procedure for well selected patients that usually have lower eyelid problems like retraction. We rarely use it for midface lift. Temple/hairline incisions may be used for endoscopic midface lift which can work only for selected patients with specific needs. In most patients volume replacement by means of fat and nono-grafts or fillers is our proffered method of "lifting" considering that midface primarily deflate rather than sag. This is done as a separate procedure or in combination with face/neck lift depending of the overall plan of treatment. Only on the basis of in person consultation one could give you a more specific options. Second opinion consultation is recommended. Good luck.

Ronald J. Edelson, MD · Answer

You have pinpointed the exact problem with that procedure. The midface will drop down dragging your lower lid with it.   Many surgeons have learned this the hard way.   Even if it doesn’t happen I’m your case the improvement a midface offers is minimal anyway. If you are a good candidate fir a facelift stick with the tried and true standard facelift.

Christine Rodgers, MD · Answer

HI Amber, Can u re-post your question with some photos? I do not like any facelift procedure that gets exposure and lift through the lower eyelid as this puts too much tension on the lower lid. Tension is responsible for bad scars so one really needs to see a photo before answering your question in a way that will help you make the right decision.Best,Dr. Christine Rodgers

Luiz Victor Carneiro, Jr., MD · Answer

Hi, today we hide the scars on natural curver and wrinkles or folds so it is difficult to see them. Regarding the lower eyelid I use to do nowadays the transconjunctival surgery, I mean the cut is inside and nobady is going to see it. Nobady.

Romy Ahluwalia, MD · Answer

Typically mid face skin laxity can be addressed through an extension of a lower lid blepharoplasty incision (this sounds like what your surgeon is suggesting).  If by lateral hairline incision you mean an incision that starts at the temples in the hairline, continues down and around the front of your ears and ends behind your ears in the lower scalp, this is a face lift incision and, depending on the vector of pull, it could certainly assist in mid face laxity.  Most typically the excess skin is vertical and the incision your surgeon is recommending is ideal.

Gilbert Lee, MD · Answer

Thank you for your questions. Without photos, I am unable to assess exactly what kind of procedure you would need. However, a midface lift is done through an incision under the eyelashes of the lower lid. It works well to lift the mid face in a vertical direction and done correctly leaves a minimal scar. I recommend you schedule a consultation with a board certified Plastic Surgeon who can assess your specific anatomy and develop a plan that is best for you. In our office we offer 3D imaging to give our patients an accurate idea of what their final result will look like. Good luck!

Douglas McGeorge, FRCS(Plast) · Answer

Lifting of the mid-face is best done through a lower eyelid incision, which extends into the crows feet area.  It needs to be a vertical lift, which does leave a scar.  It is placed to minimise the impact.  The same lift can not be achieved from a hairline incision.The muscle is fixed to the deep structures and so there should be no pull on the lower eyelids.  If the lower lid is lax it can be corrected at the same time.

Where and how visible are midface lift scars without makeup and is under the eye incision the only method?

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