What is a midface lift?
A midface lift is a procedure that lifts the cheeks. Using our technique
- fullness is created in the upper cheeks
- fullness is removed from the lower cheeks
- jowls decrease in magnitude
- the corner of the mouth is elevated
- volume is recruited to diminish the hollow under the eyes
- the lower eyelids and outer corner of the eye can be elevated.
Am I a candidate?
Pull up on your cheek and look what it does to your eyes, jowls, and the folds that run from your nose to your mouth. Look at your face lying down with a mirror. If you like what you see, you may benefit from a midface lift.
The procedure has been described elsewhere as the Ponytail LiftTM, or the MIVEL lift, and is only performed by a few surgeons using a technique that we have described— and refined.
How is a midfacelift performed?
Multiple techniques for addressing the cheeks have been described. We had the good fortune to co-edit a book written by multiple surgeons who perform midfacelift and have explored almost all these techniques personally in our practice.
We’ve arrived at a technique that involves minimal incisions, minimal downtime, and maximal– and long lasting– results. The procedure is not widely performed using our technique.
*Each patient is unique and individual results may vary.
How we perform a midface lift at WCosmetic SurgeryTM
We perform this surgery in a certified operating room in an ambulatory surgical facility. You can be awake or asleep, and you go home the same day.
We use a high definition camera and an endoscopic system that allows a magnified view of all the details of surgery—nerves, vessels, muscles ligaments, and fat…and everything that needs lifting.
Five incisions are used, all hidden above the hairline so that nothing is visible even in the early healing stages. Sutures are used to lift the volumes of the face back into place, so at the conclusion of the case, the effects of gravity on the face have essentially been addressed and reversed. Drooping of the brows and the fat pads around the eyes can be also attended to through these incisions and the procedure can be combined with upper or lower eyelid blepharoplasty as necessary.
If volume has been lost, it is addressed with microfat and structural fat grafting, and if volume has been gained in certain locations it can be removed. This is all part and parcel of the midfacelift procedure.
Unlike a facelift, no skin is removed with a midfacelift: instead, the sagging volumes of the face are positioned into the place they were in youth and the incisions are closed.
Due to the technical challenges of the procedure, we have designed several instruments that make the surgery easier and quicker. These devices are protected by patents and are currently marketed. Other surgical tools are in further development.
We call our technique the WNatural Micromidfacelift™.
The Midface Lift Consultation.
The first step for patients who are considering a midfacelift is scheduling a consultation with Dr. Wulc in Philadelphia. During this consultation, Dr. Wulc will be able to determine whether or not you are a candidate for the procedure.
We will obtain a history and make sure that your general health will allow you to undergo surgery of this sort. Other topics covered may include the type of anesthesia that will be used during the procedure, and any precautionary measures or preparations to take before the day of the surgery.
In the consult, you will have the chance to ask any questions about the procedure itself, preparation steps, and recovery from a midface lift and see examples of patients like yourself who have undergone the surgery before and at various stages during their recovery.
The main goal of the consultation with Dr. Wulc is always to educate you and to explore different options for facial rejuvenation.
Procedures that treat the midface: Why Other Techniques are not useful in our practice.
There are many techniques used to perform a midface lift by other skilled surgeons.
One popular technique is to lift the cheeks through eyelid Incisions, the transeyelid midfacelift, also called a SOOF lift. We have seen many complications with this technique, including drooping lower eyelids, dry eyes, facial paralysis and numbness due to injury of nerves.
We do not perform subperiosteal midface lifts in our practice. We see these results unfortunately from time to time. Patients who have undergone this procedure can have abnormal widening of the cheeks, prolonged swelling and overelevation (overcorrection) and abnormal facial expressions because the muscles that lift the face have been translocated and lifted into an unnatural upwards and outwards direction. Some surgeons have good results with this technique.
Another popular technique uses fillers to correct hollow cheeks and supposedly to lift the cheeks. Our research shows that these fillers help widen the face but actually weigh it down and cause the face to droop more. Too much filler also looks unnatural and creates an exaggerated fullness. Television stars such as Charlotte (Kristin Davis) in “And Just Like That” the reboot of “Sex in the City” have been accused of having this exaggerated appearance, and recently Amy Schumer had her filler removed, noting that it was making her border on the hyperinflated—saying “turns out I was already full.”
You also might be offered a thread lift as a means of improving the midface. It’s an office procedure, like a filler injection, that can be performed by a licensed provider. We have never seen a long term benefit of this procedure.
A deep plane composite facelift addresses the midface—however, the surgeon who initially described the procedure wrote an article in a definitive journal suggesting that the procedure was a disappointment in terms of its longevity. *
*Hamra, Sam T. A Study of the Long-Term Effect of Malar Fat Repositioning in Face Lift Surgery: Short-Term Success But Long-Term Failure Plastic and Reconstructive Surgery. 110(3):940-951, September 1, 2002.
The cheek lift procedure has a recovery time of approximately 9 days. Pain is generally easily controlled with a long lasting local block that occurs at the time of surgery and with pain medication as necessary after to control any discomfort. Discomfort usually only lasts for 72 hours.
Both swelling and bruising are common and fade gradually in the weeks following the procedure. We employ lasers and pulsed light to expedite healing and to decrease bruising. These treatments are enormously helpful and part of our usual after-care postop regimen.
In general, our patients appear slightly overcorrected for up to two weeks. As the bruising and swelling diminish, the cheeks arrive at a more youthful position.
For more information on the postoperative course, please visit midfaceliftphiladelphia.com what to expect.
We have followed our patients over 15 years and found that the operation is a long-lasting and durable aesthetic procedure. Our results have been published in JAMA Facial Plastic Surgery.
Articles in the medical literature that we have published regarding this procedure and its basis:
Hartstein, M, Wulc AE, Holck, D. Aesthetic Rejuvenation of the Midface, Springer, 2012.
Mally P, Czyz CN, Wulc AE. The Role of Gravity in Periorbital and Midfacial Aging. Aesthetic Surgery Journal. 2014 May 30;34(6):809-822.
Buchanan DR, Wulc AE. Contemporary thoughts on lower eyelid/midface aging. Clinics in Plastic Surgery. 2015 Jan;42(1):1-15.
Linkov G, Mally P, Czyz CN, Wulc AE. Quantification of the aesthetically desirable female midface position. Aesthetic Surg Journal. 2018: Feb 15:38: 231-240.
Hartstein ME, Wulc AE, Jolds JB, Einan Lifshitz A. Facial Contouring by targeted restoration of facial fat compartment volume: the midface. Plastic and Reconstructive Surgery 2018: Jan: 141(1):183e.
Stein R, Holds JB, Wulc AE, Swift A, Hartstein ME. Phi, Fat, and the Mathematics of a beautiful midface. Ophthalmic Plastic and Reconstructive Surgery 2018. June 21.
Buchanan DR, Wulc AE. Preperiosteal Midfacelift Through a Transtemporal Approach, in Pearls and Pitfalls in Cosmetic Oculoplastic Surgery, Hartstein, M, Massry GG, Holds JB, Springer, London. 2015:361-5. Shtraks J, Fundakowski C, Yu D, Hartstein ME, Sarcu D, Lu X, Wulc AE. Investigation of the Longevity of the Endoscopic Midface Lift. JAMA Facial Plast Surg. 2019 Nov-Dec: 535-541.
Should I get a midface lift or a facelift?
In our practice, a midface lift is done with an incision that measures approximately 1” and that is hidden above the hairline. A facelift is done with an incision that surrounds the ear and is easily concealed at the ear facial junction. A midfacelift addresses the eyes and the jowls and restores a heart shape to the face –a facelift specifically addresses blurring of the jawline and neck. A midface lift also allows us to address your brows, your forehead, your hairline and your eyes. No loose skin is removed—instead, volume that has dropped is replaced into a natural postion within the skin envelope and loose skin appears more volumized and thus loses its loose look. A facelift generally does not do any of the above and with a facelift, skin is discreetly removed from around the ear and sideburn and from the posterior hairline.
What are the benefits of a midface lift and who should get one?
Many patients seeking to improve the appearance of their eyes are sometimes advised to consider the midface lift. The incisions for this procedure are much smaller than facelift incisions, even mini facelift incisions. The benefits are also seen remote from the eyes as the surgery affects the jowls and addresses facial shape. In truth, it is a facelift, though it does not address aging changes in the neck.
A midfacelift can also be used to address lower eyelid retraction, a complication that can occur after lower blepharoplasty. With this procedure, the skin and volumes of the cheek are recruited into the lower eyelids to elevate the lids, to improve appearance, and to make the eyes more comfortable.
What are the complications of midface lift?
In our practice, the most common complications are bruising and swelling which last approximately 9-12 days, and swelling of the lid/cheek junction which we treat with radiofrequency energy.
We see complications from unsuccessful midface lifts from other practices. These include: abnormal weird appearance including too wide of the face (most common), paralysis, numbness, drooping of the lower eyelids (ectropion-second most common), and permanent swelling at the midface junction. We have recently written a chapter on midface complications which is available online.
Wulc AE. Midface lifting complications, in Avoiding and Managing Complications in Cosmetic Oculofacial surgery, Springer, Switzerland, 2020:217-228
Any consultation with your surgeon should involve asking them about who does the surgery, how many they have done, and about their complication rates. Ask us during your consultation about our complication rates. We will be happy to discuss this information with you.
How long does a midface lift last?
A midface lift in our hands has a long duration of benefit. You continue to age, but your midface stays in place. In many patients, volume loss continues to occur, but the suspension keeps the cheeks in a good position. The volume loss is easily addressed with either hyaluronic acid fillers or liposculpture—the addition of fat to the cheeks.
Why Choose Dr. Allan Wulc
He is board-certified in: