“What is overwhelmingly more common in our field is the patient who is looking for a less radical, more subtle procedure with a faster recovery,” says veteran New York City plastic surgeon Elliot W. Jacobs, M.D, FACS. “They want to look younger but they don’t want their plastic surgery procedure to be obvious. That sounds like an oxymoron but it really isn’t.”

Dr. Jacobs says that many patients in their 40’s and early 50’s, whose faces show the initial signs of aging, frequently opt for a specialized procedure known as the “midface lift.” The midface is the inverted triangular area beneath the eyes down to the corners of the mouth. It’s the area where most women’s and men’s ages first become apparent as “smile lines” form and the eyes appear droopy and tired.

The mid-facelift softens the smile lines, known medically as “naso-labial folds,” by lifting the sagging skin and underlying fat pad. The area beneath the eyes also gets some help by removing excess fat and smoothing the skin. The midface lift gently elevates all of these tissues to achieve a softened and more youthful effect for this entire area. Many of these patients are actually not candidates for classic full facelifts, which entails pulling back the skin by making incisions near the ears and which is most effective on the cheek area in front of the ears. Indeed, the traditional lift can be the wrong procedure for them to undergo, for improvement in the midfacial area is best achieved by pulling up, not back.

The midface lift is performed though an incision just below the eyelashes of the lower eyelid, which extends to the outer corner of the eye and then down and out slightly in a squint line. All the tissues of the midface are elevated and secured in a newer, higher position. Excess skin and “fat bags” of the lower eyelids are eliminated and fat is transposed to fill in any depressions between the eyelids and the cheeks. Thicker tissue is elevated onto the cheekbone area and enhances their contour. The shape of the eye is not altered and there is absolutely no “feline” appearance. The net result is a smooth, full, lifted and youthful contour.

Not only is the midface more appropriate and very effective for many patients, it also costs less than the classic facelift, about $6,000. It is a highly specialized procedure that requires an artistic eye and expert surgical skill. “The midface lift is a relative newcomer when it comes to plastic surgery,” adds Dr. Jacobs. “It’s quite intricate and you want an experienced plastic surgeon that has performed a number of them.”

Dr. Jacobs has performed about 300 midface lifts and has a portfolio of before and after photos which he shows to prospective patients. He says a simple test can determine whether one is a candidate for a midface lift. Place a finger on the cheekbone just under the outer corner of the eye and lift gently in a vertical direction. If the sagging is noticeably improved and the smile lines soften considerably, it’s likely the midface lift would be an appropriate procedure.

The procedure is performed on an outpatient basis in Dr. Jacobs’ fully accredited office surgical suite while the patient is placed under twilight sleep anesthesia. The entire operation takes about 60-90 minutes. Stitches at the eyelash lines are removed within three to five days of surgery, and while there is usually no pain, the patient will have a sense of pulling, tightness and swelling. This swelling, along with the possibility of minor bruising, usually disappears within a week and can be hidden with make up.

Dr. Jacobs is an attending plastic surgeon at the New York Eye and Ear Infirmary, and is certified by the American Board of Plastic Surgery. He is a fellow of the American College of Surgeons and serves as a consultant in plastic surgery to the United Nations.

© 2005 HealthNewsDigest.com