The mid face is the area lying between the bicanthal and oral commissure. The mid face is one of the first facial areas to show signs of aging. As individuals age, the bony skeleton and soft tissues of the face lose volume, producing a slightly wider orbital aperture and less anterior projection. This decreases the overall projection of the cheek and diminishes bony support for the overlying soft tissue structures. The preseptal orbicularis oculi muscle loses tone, resulting in herniation of the intraorbital fat.
Ptosis of midfacial adiposity exposes the inferior orbital rim. Further descent of cheek fat and separation from the suborbicularis oculi fat (SOOF) can be heralded by a faint diagonal groove in the infraorbital area parallel to the nasolabial crease. Furthermore, descent of the Bichat fat pad over the upper mandible can increase lower facial jowling.
Individuals in their early 30s may have descent of the malar fat pad; this may lead to the formation of infraorbital dark circles and deepening of the nasolabial and nasojugal (tear trough) creases. These changes occur earlier in the presence of poor bony support and midface retrusion.
During the past 15 years, several techniques have been described to specifically address the mid face, since this area is not addressed with standard cervicofacial rhytidectomy. Presently, restoration of cheek contour and volume can be achieved by performing a subperiosteal, vertically oriented lift with independent suspension of the various cheek structures. The lift can be performed with small and hidden incisions and supplemented with a cheek implant if deemed necessary.