Q: Dr. Eppley, I have a question about midface lift surgery. I read an article which described the following technique…’it returns facial volume to the upper cheek and lower eyelid area without the need for skin incisions (the two short scars are located within the scalp and mouth). Imbrication means “stacking,” as the deeper tissues of the lower cheek are stacked higher beneath those of the upper cheek. Midfacial suspension is accomplished by a single absorbable suture (this time a heavier “2-0” vicryl) positioned through the mouth incision, again without tension. Impressive improvements typically follow to the cheek, lower eyelid region, and mouth. Performed alone, however, any midface lift brings only limited improvement to the jowl complex, jawline, and neck, where most established aging resides. Therefore this “scarless” internal facelift becomes appropriate only in selected patients with earlier aging and fewer concerns about the jowl and neck region.’
My Questions: The last paragraph alludes to “limited improvement to the jowl complex, jawline and neck……”. And that makes sense because you are pulling a lot of tissue/skin straight up, a long distance. I was wondering if you would agree that a “short scar” traditional facelift might be the final piece of this puzzle? It has been about 17 years since my original facelift so maybe there is merit to a vertical midface lift and traditional facelift.
A: Thank you for the additional information. While it is true that a midface lift does not have the greatest influence on the jowl area (it is sheer function of distance from the point of pull), the author’s technique would be particularly limited because it is a midface lift that is done completely from inside the mouth and from below. (in effect a push technique) Thus it is really a very limited midface lift that is very different than the more traditional midface lift with cranial suspension. (a pull technique) These two types of midface lifts are not really synonymous/interchangeable in terms of their effects.
That being said, if one wants to cover all their bases so to speak adding an additional component of a tuck up lower facelift at the same time as the midface lift will provide some additional improvement along the jawline as well.
Dr. Barry Eppley