Question/Answer on Midface Lift

Question: Are all midface lifts done endoscopically these days? Is it now common for the procedure to be done endoscopically? Are there any advantages to having mid facelift done NOT endoscopically (can you see more, have more control, precision)? Is it enough the "standard of care" that I should look skeptically at a surgeon who doesn't do this procedure? I'm thinking of having it done to improve the sagging of my cheeks but not sure its the right procedure.

Dr. Marotta's Response: There are really only a few ways to do a true midface or cheek lift. The "endoscopic" approach you mention is done through small incisions hidden behind the hairline; 2 in the temples and 2 behind the hairline above the forehead. Through these incicisions sagging forehead and cheek tissues (upper 2/3 of the face) can be elevated giving the patient a younger appearance. This is sometimes called the "Endoscopic Forehead Midface Lift" or the "Temporal Approach to the Midface" because it bascially it was developed from the endoscopic forehead lift procedure. This is my preferred technique and I have published papers about it. Some surgeons attempt to elevate sagging cheek tissues through the same incision as a lower blepharoplasty or eyelid lift. This is called the "subciliary approach" to the midface lift. In general this approach is less effective because there is notihing in that region strong enough to hold the sagging cheek while it heals. There is no more precision in either approach inherantly and I think it depends on the skill and experience of your surgeon.

Looking at your pictures you are an excellent candidate for an endoscopic midface lift because most of your aging is due to a sagging cheek, deeper smile lines, and hollow eyes all of which a midface lift will help. In my own practice I combine an endoscopic midface lift with microfat transfer to get even more dramatic and natural looking iimprovement in these areas.

It is very important to be clear on what a midface lift does vs. a facelift. You must understand the majority of cosmetic surgeons cannot do a true midface lift because they have not received the necessary training/experience in these procedures which can be technically difficult. These surgeons may dismiss the procedure as unimportant and offer a facelift or alternate procedure that really does nothing for the sagging cheek and nasolabial folds. Most facelifts offered are some kind of SMAS lift which really helps more the lower face, jowls, and neck. From your pictures these are not your problem areas. The only facelifts which may help the cheek and smile lines are the deep plane facelift or the composite lift. These procedures again are done by surgeons with advanced training and you won't find them in every office. I do alot of deep-plane facelifts as well but would offer that more to a patient who has not only a sagging cheeks but a sagging jawline or jowls and a sagging neck and who does not want a midface lift in addition to a "lower" (jowls/neck) facelift.

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