M L
AESTHETICS
MIDFACE LIFT & LOWER EYELID BLEPHAROPLASTY
By Mr Ali Juma
This procedure is carried out to lift-up the facial skin and the layer investing the facial muscles to give the face a less tired look and younger appearance , effectively setting back time .
It must be taken into consideration that the face does not age in one or another component however , it ages at one time in all its components and must be treated accordingly . The aging process involves the skin , especially if it is sun damaged . Hence , it is not unusual that facelift and midface lift with eyelids surgery are carried out at the same time to achieve the best outcomes .
As we age , our facial muscles and the investing layer slackens and loses elasticity , thus creating lines and folds . The effect of gravity , exposure to the sun and stress also show on our face , causing folds and lines to deepen .
The bony skeleton of the face loses volume and so do the fat pads of the face . One such fat pad is in the midface and is called the sub-orbicularis oculi fat pad ( SOOF ). These changes also cause drooping at the sides of the mouth which gives a sad look and contributes to the visibility of the jowls causing a squarer face .
The objectives of the mid facelift is to improve the lower eye lids , the cheeks , the corners of the mouth and to a certain extent the jowls . To achieve further improvement to the jowls and definition to the jaw line , it will also warrant undergoing a facelift and a neck lift .
Due to ageing , the fullness of the cheeks is lost , with skin and underlying fat starting to sag from the lower eyelids downwards . The procedure of midface lift can be carried out with a lower eyelid blepharoplasty , ( eye bags reduction / removal ). Another benefit of this surgery is improvement to the creases , which extend from the side of the nose to the corners of the mouth ( nasolabial folds ).
Mid-facelift is intricate surgery and must be performed by a qualified and experienced plastic surgeon . I continue to enjoy performing such surgery even after many years of practice , as in my opinion , it is an operation that can give very good and reproducible outcomes with many happy patients .
Fat transfer can also be contemplated in some patients to use during surgery or at a later date to fill the midface and to give a more youthful look with improvement to the skin , as fat carries stem cells . It is important to say that in 20-30 % of patients , fat transfer may warrant another stage due to fat resorption .
In some patients , wrinkle relaxing injections and dermal facial fillers may be contemplated as a supplementary treatment for maximum effect , and to increase longevity of outcomes and its maintenance .
Skin treatments for aging skin resultant from sun damage must be considered , as tired looking skin will mar the results of surgery and can cause less pleasing outcomes for patients . Hence , supplementary treatments are an important discussion in the presurgery consultations .
WHAT TO EXPECT :
A midface lift is normally performed under general anaesthetic ; however , local anaesthetic with or without sedation may be contemplated in a few very selected patients .
A 1-night stay is required in hospital with a postoperative recuperation period of 3-4 weeks . Following the operation , the face will feel stiff to begin with and will appear puffy which will improve over the next 2-3 weeks . After approximately 2-3 weeks , social activities and work can begin again . Bruising is likely to occur in some patients .
Recovery may take longer in some patients as the surgery carried out was to cater for more aged lower eyelids warranting more intricate surgery . Hence , these patients can take 4-6 weeks to recover and may suffer red and watery eyes over that period and tighter feeling lower eyelids . In some patients , the swelling of the conjunctiva may need draining of fluid which helps reduce it . ‘ Pulling ’ of the lower eyelids skin may occur in a very small number of patients , however , the majority improves with lower eyelid exercises . These exercises will be demonstrated to the patient in clinic and the progress will be closely monitored . The risk of blindness is a rare , and its incidence is reported to be 1:2500 patients .
There is scarring after a midface lift , which is an extension of the lower eye bag reduction surgery . It runs just under the eyelashes of the lower eyelids and a few millimetres to the side of the lower eyelids . In the majority of patients , these scars will significantly fade away in the first 4-6 months and will continue to improve over the period of scar maturity , which is in the first 12-18 months . In a small number of patients , a mild redness to the lower eyelids skin can occur which tends to settle over time . Further information can be obtained on the day of consultation .
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