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The Midface

One of the areas that Dr. Zoumalan carefully evaluates in patients that seek cosmetic or reconstructive eyelid surgery is the midface area. The midface is defined as the middle area of the face, which is located between the lower eyelid and upper lip. The descent of midfacial structures can occur with aging, trauma, facial paralysis (Bell’s Palsy), or even prior surgery. Descent of the structures can occur through either loss of volume in that area and/or laxity of tissues. When the midface is addressed, Dr. Zoumalan attempts to either resuspend the midface to a “more anatomically appropriate” position or “fill” the area that is now depleted with volume to restore the appearance it once had.
Whether you are visiting Dr. Zoumalan for a cosmetic eyelid surgery or a reconstructive eyelid surgery, the midface will be carefully examined for any descent of structures, whether it is due to problems with volume or laxity. In cases where the midface needs to be addressed, Dr. Zoumalan will discuss all of your options with you. One involves a surgical procedure (midface lift) and the other can be done non-invasively through the use of fillers (i.e. hyaluronic injections and/or fat injections). Dr. Zoumalan will examine you and make the recommendation that best fits your needs.

What are the different types of midface lifting?

Surgical Midface Lift:

The surgical midface lift procedure is usually done in combination with lower eyelid surgery. Dr. Zoumalan usually uses the incisions used for lower eyelid surgery to access the midface components and safely and effectively resuspend them to a higher, or more anatomically appropriate, position. The downtime is usually no more than a typical lower eyelid surgery, but the midface area can be swollen for several weeks. The incisions are usually hidden inside the eyelid and the skin incisions that are made are typically concealed in natural wrinkles. Dr. Zoumalan specializes in Oculoplastic surgery that addresses issues concerning the eyelid and surrounding structures, including the midface area.

Non-surgical Midface Lift:

Volume augmentation is a non-surgical option for certain patients that may not require surgery. This is often the case in patients with mild midface descent or ones who may not require lower eyelid surgery. Various products can be used; Dr. Zoumalan will sit down with you to go over your options. Hyaluronic acids are quite effective, although the results are not long lasting. The advantage, though, is that this procedure can be done safely in the office, usually under topical anesthesia only. Dr. Zoumalan uses a cannula to inject his fillers in the office rather than a needle, which helps to reduce the rate of bruising, increases patient comfort and results, and is much safer in his opinion. Fat grafting can be an excellent option for some patients; fat grafting can often last for several years, if done appropriately.
Both produce desirable results, but appropriate patient selection must be performed. Dr. Zoumalan often employs surgical midface lifting (SOOF lifting) in cases of revisional eyelid surgery, where the elevation of the midface allows for a better contour and appearance to already surgically operated eyelids. Midface lifting can also help in reposition the midface in those that have had a prior facial nerve paralysis.
In cosmetic cases where patients have volume loss in the midface, Dr. Zoumalan often recommends volume augmentation. The downtime is quicker than traditional midface lifting surgery and patients can expect a natural-looking result. Hyaluronic acid fillers or fat grafting can be used to augment the midface. This can be done at the same time as eyelid surgery or by itself in the office.

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    Preoperative Diagnosis: Lower lid retraction.

    Procedure performed: Lower lid retraction using a hard palate graft, canthoplasty, and midface lift.

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    Preoperative Diagnosis: Left lower lid retraction from facial nerve palsy and difficulty closing left eye.

    She underwent a midface lift and lid resuspension to help elevate her lid to help her close her eyelids more appropriately. A posterior spacer graft was also used in the lid retraction repair. After the surgery, she was able to close her lids better and her symptoms had all resolved.

    Procedure performed: Left lower lid reconstruction using canthoplasty and tissue graft to lower lid as a posterior spacer.