Technique Selection in Mid Face Lift Surgery

For patients who are uncomfortable with deformities in the mid-face area, there are options such as mid-face filler, mid-face fat injection and mid-face lift surgery. In our previous articles, we have stated that mid-face lift surgery is superior in terms of permanence and can shape the face without adding extra volume to the face. Suppose you decide to have a mid-face lift surgery on your journey to improve the midface.

Mid-face lift surgery can be performed with many different techniques and approaches, and all of them have their own advantages and disadvantages. So, which is the right mid-facelift surgery technique for you? Without going into too much detail, let's review the techniques with their main advantages and disadvantages:

Transoral-Transtemporal Midface Lift

In this technique, an incision is made through the hair and through the mouth. The midface is released through the mouth and the temporal area is released through the hair. These two cavities are connected to each other. An endoscope is usually used during the procedure, but when the incisions in the mouth and temple are 3 cm or more in size, the procedure can easily be performed without the use of an endoscope.

Advantages:

It is simple and quick.
Since it does not require an incision around the eye, eye discomfort is very rare and eyelid-related complications are almost never seen.
It does not leave a visible scar.
It emphasises this structure in patients with weak cheekbones.

Disadvantages:

Intraoral incision carries a 5-7% risk of infection.
Permanent and braided suture materials are generally not used due to the risk of infection.
When absorption suture materials are preferred, there is a 10-15% risk of relapse (re-falling of the tissue).
Long sling sutures may cause temporary compression of muscle and nerve tissues.
Intraoral incision may cause mild loss of movement and sensation in the upper lip, but these usually resolve spontaneously.

Subsilier Mid Face Lift

In this technique, an incision is made at the base of the lower eyelid eyelashes. The midface is freed from this incision. It can be considered as performing both lower eyelid and midface surgery together. Most of the time, this technique is combined with temporal lift, but this is not a necessity.

Advantages:

The lower eyelid can be included in the treatment (excess skin can be removed, bags can be reduced, eyelid angle can be changed).
The tissue can be moved directly upwards and collected directly under the eye. It is an important advantage in patients who do not want the cheekbone to be prominent.
The tissue can be fixed to the bone. Bone fixation increases the permanence of the surgery and greatly reduces the risk of relapse.

Disadvantages:

Eyelid-related disorders and complications can be seen after this technique.

Transconjunctival Mid Face Lift

In this technique, an incision is made on the inside of the lower eyelid. The skin is not removed. The entire midface is released through this incision. The technique can be applied alone or combined with temporal lift.

Advantages:

It leaves no visible scar.
It reduces the possibility of lower eyelid complications.
It is a very good option for male patients.
Both vertical and oblique (diagonal) tissue movement can be achieved.
The risk of infection is very low.
Bone fixation can be performed, permanent sutures can be used.
Under-eye bags can be reduced simultaneously.

Disadvantages:

It is technically difficult.
It is usually a more expensive operation.
It is not a good option in patients with excess skin.

SubSMAS Mid Face Lift

In this surgery, an incision is made in the temple area. Through this incision, the tissue required for temporal lift and brow lift procedures is released. The surgical release is extended to the midface. The midface tissue is fixed to the chewing muscle and bone membrane in the temple with sutures.

Advantages:

Leaves no visible scarring.
Less oedematous and faster healing than the above on-bone techniques.
Complications around the eyes are very, very rare.

Disadvantages:

Since it is an operation that proceeds in the tissue plane through which the nerves pass, it is an operation that does not tolerate little experience or carelessness. There is a possibility of nerve injury.
It is technically difficult.
The tissue can be moved obliquely (diagonally), it cannot be fixed directly vertically under the eye.
Temporary dimpling due to suspension stitches is common.
Since it uses the same surgical plane, it makes a future deep plan facelift surgery difficult and more risky.

Each technique has an ideal patient group. As in every field of facial aesthetics, it is inconvenient for surgeons to be a fanatic of a single technique in mid-facelift surgeries. When the same technique is used in every patient, it will be inevitable to have results that are not suitable for the anatomy and expectations of a group of patients. We use all of these four techniques in our clinic. In the preoperative interview, following the examination and after understanding the patient's expectations, priorities and risk tolerance, we choose a personalised technique.

You can contact us for more detailed information about mid-facelift surgery options.

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Stay nice.

O.B.