What’s the best procedure for mid-face rejuvenation?
People dealing with facial aging particularly in the mid-face area will often assume that
they need a mid-face lift.
However, what is seen as sagging, or skin or tissue laxity may actually be more a loss
of projection and definition due to age-related volume loss.
I’ll discuss my experience, and my approach to mid-face rejuvenation.
I’m Dr. Amiya Prasad, I’m a Board-certified cosmetic surgeon, and a Fellowship-trained
oculofacial plastic and reconstructive surgeon.
I’ve been in practice in New York, and Long Island for over 25 years.
As a cosmetic surgeon focused on treating facial aging, I perform all types of facelift
surgeries, including mid-face lifts.
The experience and knowledge of facial anatomy as a surgeon has guided my approach to the
precise placement of cosmetic fillers at the deeper bone level to restore age related bone
volume loss.
I recall how in the late 90s, facial aging in the mid-face was seen as a problem caused
by laxity and vertical descent of the soft tissue in the mid face.
Different types of mid face lift procedures were being developed using new endoscopic
Mid-facelifts are not the same as facelifts, which include SMAS facelifts, deep plane facelifts,
or short-scar mini facelifts.
Full facelifts are meant to address sagging skin, tissue, and as well as tighten the underlying
facial muscle foundation called the SMAS, short for the superficial musculo aponeurotic
These different facelifts, which range with the extent of surgery appropriate for different
age brackets usually start with an incision along the front of the ear, and can extend
behind the ear, so skin be trimmed and lifted, the underlying muscle tightened, and soft
tissue repositioned.
The skin is then redraped, and the incision is closed along the front of the ear.
With mid-facelifts, only lifting the mid face is addressed, so the incision is made in the
temple for surgical lifting of this area only.
In my opinion, these midface lifting strategies addressed a small part of the more significant
cause for a deflated and sagging appearance in this area: Volume loss.
This doesn’t mean that there was no recognition of volume loss, as surgeons often advocated
combining midface lift and fat grafting to add volume.
It’s important to understand that as we age, bone, muscle, fat, and soft tissue decrease,
with bone loss being the most significant.
For example, cheek bone volume loss can make the skin over the cheeks appear to sag, as
the volume that once gave the cheek skin its structure and support is now lost.
Having performed mid-facelifts in the past, as well as surgical placement of cheek implants
to restore volume, I’ve changed my approach to the mid face by focusing on the bone loss
and using new techniques to approach this problem.
For most of my patients, I restore mid-face volume using a specialized method to place
long lasting hyaluronic acid fillers at the bone level in a way comparable to the placement
of facial implants.
Traditional filler placement at the mid-face is usually done at a more superficial level
of the soft tissue.
At this level the skin is unable to support any substantial filler volume.
The filler material will oftentimes migrate, so you can look soft, doughy, and even bloated.
With an understanding of the deeper anatomy of the face from performing facelift and other
facial surgeries, I’m able to precisely place filler at the deeper bone level, and
avoid migration that is seen when filler is placed in the soft tissue.
Placing filler at the foundational bone level actually improves the definition your facial
bone structure.
This method is called Structural Volumizing.
At this time, my filler preference are thicker hyaluronic acid fillers such as Juvederm Ultra
Plus and Juvederm Voluma.
Hyaluronic acid is found naturally in the body, so these fillers are quite biocompatible
and are safely metabolized with time.
We perform structural volumizing for the midface routinely in our office.
Many of our patients come in during their lunchtime and return to work right after.
Your results can be seen immediately after the procedure, however we allow for 2 weeks
to let the material settle into the space it was placed into.
I see my patients in 2 weeks and see if any enhancement would be of benefit.
Generally speaking, one of the first noticeable effect of aging in the mid-face is characterized
by volume loss, leading to you having less projection and definition.
As opposed to surgery and fat grafting, the strategic placement of filler at the bone
level can add structure, definition, as well a subtle lifting effect, without surgery.
I hope you found this information from my experience helpful.
If you’re interested in recommendations for your individual situation, you may contact
us through our websites or call our offices to schedule a consultation.
Thank you.