What is the least invasive surgery to lift the Midface?

I have mild ectropion in my left eye and my left cheek is droopy. I heard surgery through the lower lid make result in retraction, and performing surgery through the temple also may involve damaging the facial nerves? Is there any type of surgery that can be done that does not involve risk of damaging the facial nerve....any suggestions?

Doctor Answers 8

Lifting the Midface?

Photos would certainly be helpful in answering your questions. I would also start by asking why you have an ectropion of your left lower lid. Is this the problem you are trying to fix? There can be a number of causes for ectropion and many of them are intrinsic to the eyelid itself, so a mid-face lift would not be the solution. Instead the more appropriate correction may involve surgery of the lower lid. You are also correct in that the lower lid approach to a mid-face lift is associated with a high incidence of lid retraction (because of the disruption and trauma to the delicate lower lid structures), and the temporal approach is a long way away from what you are trying to fix, and by necessity must therefore traverse the course of multiple facial nerves. 

For all of these reasons isolated mid-face lifts are being done increasingly less frequently because they accomplish very little and actually result in extensive trauma to the deeper tissue layers of the face. Unfortunately they are often presented as "minimally" invasive because they are performed through small incisions along with the use of an endoscope. But it is what goes on beneath the skin which is most important and also what carries the greatest risks and creates the most trauma. Any surgical procedure which extends into the deeper layers of the face below the skin carries some risk of facial nerve injury. It is the responsibility of the surgeon to have detailed knowledge of the facial anatomy and extensive experience with whatever technique is most  appropriate to solve the problem at hand, whether it be functional or cosmetic in nature 

Least invasive surgery to lift midface

it is difficult to render an opinion without photos, but given that you already have ectropion, that needs to be repaired and can be done safely. You may be a candidate for structural fat grafting to the midface which could give lift without the risks of traditional face lifting. See a board certified plastic surgeon for an in person consultation as a good starting point. 

Lily Lee, MD
Pasadena Plastic Surgeon
5.0 out of 5 stars 22 reviews

Least Invasive Surgery For Midface

It would be most helpful to see photos of you, or to have an in-office examination. Without either of these, I can't discuss the minute details of your specific case.  However, in general, I can say that you are correct on both counts:  I would likely not go near the lower eyelid because of potential future postoperative cicatrical contracture. In that same vein, the temporal region is too far away from the area you describe as wanting to improve. A carefully performed midface suspension with a central vector focusing on the drooping face and a superior vector could likely fix both of your problems.

Least invasive facelift not always the same as safest

Facelift procedures and variations such as cheeklifts need to be customized to the individual, and when there is an existing problem that needs to be addressed. If you have ectropion already I would not recommend cheeklifting through the eyelid, but a temporal lift should be safe. Without knowing the details of your situation, it seems that the most covservative approach would start with fat grafting for volumization of the cheek.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 45 reviews

Surgery to lift the mid face

 When patients have a flat maxilla and a flat cheek profile, temporary fillers can be performed in the office setting to add volume to the mid-face. When patients desire permanent augmentation, consider cheek implants. Cheek implants are composed of Silastic, and are manufactured in large variety of sizes and shapes. The implants are placed through an intra--oral approach under brief general anesthesia. BEFORE performing any surgery on the mid-face, it's important to have the Scleral show repaired by an ocular plastic surgeon separately.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

Facial Fillers will Improve the Mid-Face

All surgery has potential risks; however, the object is to minimize them.  A surgeon who is well versed in performing a particular type of surgery would be a good choice for any patient seeking cosmetic surgery of the face. Facial fillers, Radiesse and Voluma, are well tolerated by the body and are capable of lifting, contouring and smoothing the mid-face.  Potential complications are minimal in experienced hands.  A Liquid Facelift utilizing these and other products offer results that are visible within days of the procedure and afford the patient minimal down-time.  

Facelift surgery and the issue of risks

All types of facelift surgery come with risk.  However, board-certified plastic surgeons who perform this routinely in their practice (ideally for more than 10 years) have impressive safety profile.  Take note that the success rate of plastic surgery is largely determined by experience. 

Experience teaches us how to predict the results and pinpoint potential problems before, during, and after surgery. 

If you want to avoid surgery altogether, you may want to consider non-surgical alternatives such as Botox and dermal fillers.  However, they have their own limitations which you must understand. 

For photo reference, please feel free to visit the attached link.

Good luck and best wishes. 

Fat grafting to aid in support of lower eyelid retraction

Fat grafting to the midface will correct mild lower lid ectropion in most cases. Patients with more severe ectropion (eyelid retraction) related to previous eyelid surgery or scarring may need additional procedures to improve lower eyelid support.

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.