Facial Aesthetic

Midface Lift and Augmentation

A midface lift and midface implant augmentation are procedures designed to restore or enhance cheek volume, improve lower eyelid support, and correct age- or anatomy-related midfacial flattening. A midface lift elevates the descended soft tissues of the cheeks to restore fullness, improve lower eyelid hollowing and tear-troughs, and create a more youthful cheek contour. In this technique, a small incision is placed hidden within the hair at the temple. Through this access point, the midface tissues are released and resuspended using sutures to lift the cheek fat pads back to their natural, higher position. This helps smooth the lower eyelid-cheek junction and increases fullness in the malar region.

Midface Augmentation

Midface implant augmentation adds long-lasting structural support and volume to the cheeks using implants made from porous polyethylene or other biocompatible materials. For minor deficiencies, structural fat grafting with or without a midface lift is preferred. Implants can help restore cheek projection and support the lower eyelids in patients with more pronounced midface retrusion.

Implants can be inserted through several approaches. A subciliary or mid-lid incision (just beneath or within the lower eyelid crease) allows precise placement under direct vision. Alternatively, an upper buccal incision inside the mouth provides access without a visible scar. The approach is chosen based on the individual's anatomy and whether the implant is being combined with other eyelid or midface procedures.

For patients whose midface concerns are primarily due to underlying skeletal issues, such as an underbite, midfacial advancement surgery (orthognathic surgery) may be more appropriate than a soft tissue lift or implant alone. This surgery repositions the midface and upper jaw to improve facial balance, correct malocclusion, and enhance airway function. Midface implants may be used following orthognathic surgery to further enhance midface projection.

Virtual Surgical Planning (VSP)

Before surgery, a CT scan creates a three-dimensional model of the facial skeleton. This model allows the surgeon to design the exact implant shape, size, and position to match the patient's anatomy. VSP improves accuracy, helps plan fixation points, and allows creation of custom or patient-specific implants. This reduces operative guesswork and improves symmetry and overall aesthetic outcomes.

Indications

A midface lift or midface augmentation may be suitable for people who notice flattening or reduced cheek projection due to ageing or natural anatomy. It can also benefit individuals with:

Prominent tear troughs or hollowing beneath the lower eyelids
Descent of the cheek fat pads creating a tired or drawn appearance
Early jowling and heaviness in the midface
Weak or under-projected cheekbones
Lower eyelid support issues such as pseudo-herniation or a lengthened lower eyelid
Facial asymmetry affecting the cheeks

What to Expect

First Week

Swelling, bruising, and a feeling of tightness in the cheeks and lower eyelids are expected. Mild discomfort or pressure is common. Temporary numbness of the cheeks or upper lip may occur. If the implant was inserted through the mouth, patients may notice stiffness or difficulty opening the mouth fully; a soft diet is recommended. Cold compresses and sleeping with the head elevated help reduce swelling. Intraoral incisions should be rinsed with antiseptic mouthwash after meals. Lower eyelid incisions must be kept clean and dry, and ointment may be applied. Permanent stitches along the lower eyelid incision are removed at five to seven days; dissolving sutures are typically used for temporal and intraoral incisions.

Weeks Two to Three

Bruising fades and swelling continues to improve. Most patients feel comfortable returning to work or social activities. Light exercise can generally resume, but strenuous activity, bending, and heavy lifting should still be avoided. The cheeks begin to feel more natural as healing progresses.

After Four Weeks

Most swelling has settled, though subtle fullness may take several months to fully resolve. Final contour, projection, and symmetry continue to refine as tissues adapt around the implant. Patients can return to full physical activity including heavy lifting and sports after six weeks. Sensation gradually returns over several weeks to months, and the implant should feel stable and integrated with normal facial movement.

Possible Risks

While complications are uncommon, they may include bleeding, infection, delayed wound healing, or prolonged swelling. Temporary numbness of the cheeks, upper lip, or teeth can occur. Implant-specific risks include asymmetry, malposition, visibility, or the need for revision. Rarely, lower eyelid retraction, dryness, or shape changes can occur if a lower eyelid incision is used. Facial weakness affecting the brow is uncommon but generally temporary. Long-term, there is a very small risk of implant infection, exposure, or the need for removal.

If you have any queries about midface surgery or would like to arrange a consultation, please contact us at Terrace Plastic Surgery.

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Note that for facelift procedures in Brisbane, Dr Phua follows AHPRA requirements that include a minimum of two consultations, a cooling-off period before offering surgery, and screening for dysmorphic body disorder.

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