Patients who are bothered by deformities in the midface region have several treatment options such as midface fillers, midface fat injection, and midface lift surgery. In our previous articles, we mentioned that midface lift surgery is superior in terms of longevity and can reshape the face without adding extra volume. Let us assume that you have decided to undergo midface lift surgery on your journey to improve the midface.

Midface lift surgery can be performed with many different techniques and approaches, each having its own advantages and disadvantages. So, which midface lift technique is the most suitable for you? Without going into too much detail, let us briefly review the techniques with their main advantages and disadvantages:

Transoral-Transtemporal Midface Lift 

In this technique, one incision is made inside the hairline and another inside the mouth. The midface is released through the oral incision and the temple area is released through the incision inside the hair. These two spaces are then connected. During the procedure, an endoscope is usually used, but when the incisions inside the mouth and the temple are 3 cm or larger, the procedure can also be performed comfortably without using an endoscope.

Advantages:

• It is simple and quick.
• Since it does not require an incision around the eye, eye-related problems are very rare and eyelid-related complications are almost never seen.
• It leaves no visible scar.
• It enhances the cheekbone structure in patients with weak cheekbones.

Disadvantages:

• The intraoral incision carries an infection risk of about 5–7%.
• Permanent braided sutures are generally not used due to the risk of infection.
• When absorbable sutures are used, there is approximately a 10–15% risk of relapse (the tissue sagging again).
• Long suspension sutures may cause temporary compression in muscle and nerve tissues.
• The intraoral incision may cause mild movement and sensation loss in the upper lip, but these usually resolve spontaneously.

Subciliary Midface Lift 

In this technique, an incision is made along the lower eyelid lash line. The midface is released through this incision. It can be considered as a procedure where both the lower eyelid and the midface are treated simultaneously. Most of the time, this technique is combined with temporal lift, but this is not mandatory.

Advantages:

• The lower eyelid can also be treated (excess skin can be removed, bags can be reduced, and the eyelid angle can be adjusted).
• The tissue can be moved directly upward and positioned under the eye. This is an important advantage for patients who do not want a more prominent cheekbone.
• The tissue can be fixed to the bone. Bone fixation increases the longevity of the surgery and significantly reduces the risk of relapse.

Disadvantages:

• Eyelid-related discomforts and complications may occur after this technique.

A subperiosteal midface lift surgery performed using the “Intra-orbital Fixation” technique developed by Dr. Ozan Bitik.
Image dates: 15/02/2020 – 08/02/2021

Transconjunctival Midface Lift 

In this technique, an incision is made on the inner surface of the lower eyelid. No skin is removed. The entire midface is released through this incision. The technique can be performed alone or combined with a temporal lift.

Advantages:

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

Disadvantages:

• Technically challenging.
• Generally a more expensive operation.
• Not a good option for patients with significant excess skin.

 

A SMAS-under supraperiosteal midface lift surgery performed using the “Sub-SMAS reconstruction of retaining ligaments” technique developed by Dr. Ozan Bitik.

Image dates: May 8, 2024 – February 2, 2025

 

SubSMAS Midface Lift 

In this procedure, an incision is made in the temple region. Through this incision, the tissue required for temporal lifting and brow elevation is released. The surgical release is extended into the midface. The midface tissue is then fixed with suspension sutures to the chewing muscle and the periosteum in the temple area.

Advantages:

• It leaves no visible scar.
• Compared to the above bone-level techniques, it causes less swelling and provides faster recovery.
• Eye-related complications are very rare.

Disadvantages:

• Since the surgery is performed within the tissue plane where nerves pass, it does not tolerate inexperience or lack of precision. There is a risk of nerve injury.
• Technically challenging.
• The tissue can be moved obliquely (diagonally) but cannot be fixed directly upward under the eye.
• Temporary dimpling related to suspension sutures is frequently seen.
• Since it uses the same surgical plane, it may complicate and increase the risk of a future deep-plane facelift surgery.

Each technique has its ideal patient group. As in every field of facial aesthetics, it can be problematic for surgeons to become devoted to a single technique in midface lift surgeries. When the same technique is applied to every patient, it becomes inevitable that some patients will have results that are not suitable for their anatomy and expectations. In our clinic, we use all four of these techniques. After the examination during the preoperative consultation and after understanding the patient’s expectations, priorities, and risk tolerance, we select the most appropriate technique on an individual basis.

For more detailed information about midface lift surgery options, you can contact us.

Stay well,
Stay beautiful.

O.B.