Midface Lift

After Mid Lift Surgery

Traditionally, the mid face has always been an area of the face that has been somewhat neglected by patients and surgeons alike. Most people pay attention mainly to the neck, the jawline, eyelids and forehead and request treatment for this. Of course the various facelift and blepharoplasty techniques on offer can satisfactorily address the above. However the area below the lower eyelids and your mouth as well as around the cheekbones –the area called the mid-face- has always been somewhat trickier. As you age, the effects of gravity, repeated muscle contraction, and lifestyle cause the skin, fat, and muscle in this region to move downwards. When this occurs, the cheeks begin to look saggy or flat, the lower eyelids can become puffy or hollow, and circles begin to appear under the eyes. Furthermore the lines between the nose and the corner of the mouth deepen.
As a result newer techniques have been developed to improve this flattening and the descent seen in the mid face, and which can be successfully addressed with a Mid face lift. This procedure effectively lifts the middle segment of the face by restoring the volume and fullness as well as enhancing the appearance of the cheekbones. When performed skillfully, a midface lift will deliver a natural but noticeable improvement.

Midface Lift FAQs

Am I suitable candidate?

The best candidate for a facelift is a man or woman whose face and neck have begun to sag, but whose skin still has some elasticity. There is no need to wait until hanging folds or almost irreversible changes have taken place. In fact increasingly these procedures are being carried out on younger patients. These days, many patients prefer earlier corrections to maintain youthful appearances, and therefore avoid living through a period of looking "old and tired". If your cheeks are sagging or have flattened over the years, if your lower eyelids are puffy with dark circles or have "hollowed out," or if your smile lines have deepened, you’re probably a good candidate for a midface suspension. Of course the best way to determine if a midface suspension is right for you is by a thorough consultation with your surgeon.

At the time of consultation Mr. Karidis will ask you about your general medical history, specifically pertaining to any medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood clotting problems, or a tendency to form excessive scars. Slight differences in facial symmetry are normal and will be pointed out as many times these are unnoticed by the patient.
If you are a smoker you will be asked to stop smoking well in advance of surgery as well as for a period after the operation(generally 4 weeks before and 4 weeks after). Smoking seriously constricts blood vessels and therefore decreases blood flow to a given area resulting in poor healing. Aspirin and certain anti-inflammatory drugs and other medications (discussed in DO'& DON'TS section) can cause increased bleeding, so you should avoid these.

If you're contemplating a mid-facelift surgery, this information will give you a basic understanding of the procedure. It can't answer all your questions since a lot depends on the individual patient. However, any specific questions should always be addressed at the consultation.

What is the aim of the Mid face lift ?

The aim of the mid-face lift is to restore the natural curves and fullness in the cheeks by moving soft tissues back to where they were earlier. This is achieved by elevating the soft midface tissue from the bone, repositioning it upward towards the eyes, and fixating it in place until it readheres naturally to the bone. This restores cheek volume and establishes more youthful midface contours. The result will be a natural, revitalized appearance that doesn’t appear overdone or "pulled." A new approach for midface suspension allows Mr. Karidis to quickly lift and secure tissue at a new, more youthful position by using an implant called the ENDOTINE Midface device. This innovative device offers a predictable alternative for cheek suspension, enabling shortened surgical times and improved aesthetic outcomes.

What is the advantage of the Endotine Mid face lift over suture suspension?

By eliminating the need for fixation sutures which are the most commonly used devices for midface suspension, surgeons find the ENDOTINE Midface much simpler and easier to use. It is well known that while suture suspension is effective in experienced hands, it also carries with it potential challenges, such as nerve entrapment, dimpling of tissue, tissue tear-through, extended operating time and surgeon frustration with lack of ability to adjust placement.

What does the operation involve? (also see animated procedure section)

During a midface lift procedure, Mr. Karidis makes small incisions in the hair bearing skin of the temple as well as through the underside of the upper lip. A small endoscope and other instruments are introduced through the incisions to lift the delicate midface tissues off the cheekbones. Once lifted, these tissues are repositioned upward (toward the eye) and to the side (toward the ear). However recently a new device -called Endotine Midface device- has improved the midface lift technique even more. This new approach features this ENDOTINE Midface device, which has five small tissue holders, or tines as they are called, to grasp the cheek tissue gently but securely and elevate it (and all overlying cheek tissue layers) to a new position. In this way, it can reduce the skin irregularities and dimpling that commonly occur when sutures are used. The tines also distribute the tissue forces evenly, minimizing the chance of surgical failure and possible injury caused by sutures. Once implanted, the device gradually absorbs until it is completely gone. By this time the tissues have fixed into position. This is an improvement over non-absorbable sutures, which remain permanently implanted long after they are no longer needed for fixation.

Watch the procedure in Virtual 3d

What type of anaesthesia is used and how long does the surgery take?

Mr. Karidis prefers to use a general anaesthetic to perform the mid face lift. On its own a midface lift takes about 45 minutes to perform. Of course if associated surgery such as eyelid and lower facelift surgery is performed then the overall surgery time is extended. Using the ENDOTINE Midface device shortens the length of the procedure by up to 30 to 40 minutes and likely reduces the swelling associated with more prolonged techniques. Patients can go home the same day.

What happens after surgery?

Immediately after surgery, you will experience some temporary swelling and bruising in your midface region, which may take several weeks to completely resolve. You will also feel the middle part of your face somewhat rigid and expression in this area, including the mouth region will be stiff. Of course this subsides after 10-14 days. The first night, it’s important to rest with your head elevated to decrease swelling and bruising. You can use a cold compress for comfort and to help control swelling.

Post Operative Instructions

What kind of after effects should I expect?

Performing the mid face lift with the Endotine device is considered a minimally invasive type of procedure. As such obvious signs of surgery such as bruising and swelling are more limited than in conventional surgery. Nonetheless do expect some swelling and stiffness in the region for the first 3 weeks. Rarely, temporary weakness of the muscles, due to nerve trauma, can also lead to decreased or limited movements of the muscles in the region. However this usually subsides in the first month or so. Occasionally patients may feel the ENDOTINE Midface device under the cheek, but it is not likely to be visible. It will become less palpable as it begins to absorb in the months following surgery.

Can the mid face lift be combined with other facial operations?

Yes indeed. Many patients who consider this type of surgery also request improvements to the neck, brow and eyelid regions and can in fact undergo simultaneous work these areas as well.

What are the scars like?

As the incisions are small and in hidden areas these cannot be readily seen. You will have a small 1 inch scar in the hair bearing skin of each temple as well as a small 1 inch scar inside the mouth, on the inside of the upper lip. All sutures used are of the dissolving type. All the above scars usually heal very well and will be difficult to locate in the months afterwards.

Is it painful?

Thankfully the mid face lift using the Endotine device is not considered particularly painful. You will however feel some discomfort in the middle part of the face for the first few days. This however is well controlled with the use of prescribed pain killers. Occasionally the temple incisions can be somewhat sensitive due to the swelling and sutures.

What could go wrong?

All surgery carries some uncertainty and risk. When a mid face suspension is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Complications that can occur include Haematoma (a collection of blood under the skin that sometimes must be drained by the surgeon), minor infections, scar lumpiness and distortion (usually temporary).

Sometimes patient may be able to feel the ENDOTINE Midface device under the cheek skin, which may be sensitive to touch. The ENDOTINE Midface device is designed to minimize the risk of injury to bodily structures in the surgical area, although they are at risk with any technique. Should problems specifically associated with the ENDOTINE Midface device occur, it may be decides to remove it rather than wait for it to dissolve.
You can reduce your risks by closely following Mr. Karidis's advice both before and after surgery.

How long before I am back to normal?

You should be up and about in a day or two, but plan on taking it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin may be both tender and numb, and may not respond normally at first. Avoid strenuous activity, including sex, and heavy housework, for at least two weeks. Mild stretching and walking are fine. Above all, get plenty of rest and allow your body to spend its energy on healing.

At the beginning your face may look and feel rather strange. Your features may be distorted from the swelling, and your facial movements may be slightly stiff. It's not surprising therefore that some patients are disappointed and depressed at first. However by the end of the first week, you'll start to look and feel much better. Most patients are back at work from about ten days to two weeks after surgery. If you need it, camouflage makeup can mask most bruising that remains.

How many mid face lifts does Mr. Karidis perform?

As the Endotine mid face device has only been approved for use in the UK since 2006 the numbers of patients that Mr. Karidis has performed the procedure since its launch, and according to his annual audit figures, currently (October 2007) stands at 10.


The midface area is an important consideration when thinking about facial rejuvenation. In suitable candidates a mid facelift, using the Endotine device effectively addresses the concerns of middle-aged women and men who want to look rejuvenated in a subtle, natural way with less bruising, swelling and downtime.

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