As with every surgical procedure midface lift is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.
The most common surgical complications after midface lift include:
- postoperative bleeding, hematoma
- under- or overcorrection
- unsightly or asymmetrical scars
- persistent swelling
- ectropion (sagging eyelid leading to incomplete lid closure and problems with tear production)
- irritation of the conjunctiva or cornea
Rare complications after midface lift include:
- delayed wound healing, wound breakdown or skin slough
- corneal injury
- permanent incomplete lid closure
- bleeding into the eye socket, if left untreated blindness
- injury of the tear duct
The operation is usually performed under general anaesthetic and usually as an outpatient procedure.
The skin incision for the midface lift is the same as for a lower eyelid blepharoplasty and runs along the edge of the lower eyelid, just below the eyelashes. Laterally the incision usually needs to be extended for 1-2 cm beyond the bony orbit, but is hardly visible as it can be placed inside an existing skin crease. Through this approach the cheek fat pad can be freed and elevated to sit above the cheek bone where it is held in place with deep sutures. If the so-called tarsal plate, which is a thick band of tissue which stabilizes the edge of the eyelid, is loose it may need to be tightened. The procedure is completed by removing the often only very thin strip of excess skin, after which the wound edges are sutured together.
The skin incisions are usually closed with fine non-absorbing sutures, which are removed after approximately 7 days.
What to expect after the operation
The skin around the eye is very thin and prone to swelling and discoloration. As hematomas and swelling follow gravity, it is therefore very common for the entire eyelid and cheek area, to swell up and turn blue. This can be reduced by cooling the area immediately after surgery for 24-48 h and keeping the head slightly elevated. It is advisable not to schedule the surgery within 2-3 weeks before a public event.
The final result can usually be appreciated after about 6-8 weeks, once all the postoperative swelling has gone down.
Keep the head slightly elevated (at least 30 deg) and cool the eyelids (not with ice as it can cause thermal damage) for at least 48 h after surgery
The sutures will be removed approximately 7 days after surgery and the dressings can be left intact until then.
Showering and washing your hair is usually allowed after 48h, however rubbing the eyelids should be avoided until the wounds have healed completely.
Makeup can be applied anywhere more than 1cm away from the wounds after 48h.
Everyday activities are usually possible immediately after surgery, however strenuous activities, including exercise should be avoided until the swelling has gone down.
Regular follow-up appointments with your surgeon will be scheduled at 1 week, 6 weeks, 3 months and 1 year after surgery.
Do I need to stop my own medication prior to surgery?
Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.
Does my GP need to perform or organize any special investigations or tests before surgery?
Usually not. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.
Do I need to stop smoking before surgery?
We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.
How long before I can go back to work after surgery?
This depends on your work. Light duties, such as office jobs can usually be resumed immediately after surgery. However, your eyelids will be quite swollen and discoloured for at least a week after the procedure, so it is advisable not to schedule your surgery immediately before any public events.
Which is the ideal age to have a midface lift?
There is no real “ideal age” for any aesthetic procedure, especially as each individual ages differently and has a different perception of their appearance. Most importantly the expectations of what changes can be achieved must be realistic and the potential physical and psychological benefits of any aesthetic procedure must outweigh both the surgical and anaesthetic risks. In general, the midface lift is more suitable for younger patients with only mild signs of ageing.
How long does a midface lift last?
This is highly individual. No aesthetic procedure can stop the ageing process, as both the changes of the tissues themselves and the effects of gravity remain ongoing. Due to the strong forces on the tissues caused by the facial muscles, a midface lift usually does not last as long as a full facelift.
I already had a midface lift in the past. Can the procedure be repeated?
Technically yes, lifting procedures can be repeated, however the risk of complications are higher as the anatomy becomes distorted through scarring and the quality of the skin and soft tissue suffer with each re-do procedure. The expectations of the aesthetic outcome cannot be the same as for the first operation and it may be necessary to change the surgical strategy to a more extensive procedure like a full face lift to achieve a satisfying result.
I would like a midface lift and a upper eyelid blepharoplasty. Can this be done in the same operation?
Yes, it is technically possible and done so routinely. The operation and recovery time will be prolonged slightly.
I often have swollen eyelids, especially in the morning or when I am tired. Will this go away after surgery?
Eyelid swelling is caused by many factors, including the anatomy and function of the lymphatic vessels within the skin and underlying tissue. The tissue’s increased tendency to swelling is something that cannot be corrected surgically, however most patients do notice a significant improvement after the procedure.
I have dark circles under my eyes, will these be corrected with a midface lift?
Possibly to a certain degree. As with eyelid swelling there are many reasons for dark circles under the eyes, foremost the fact that the eyelid skin is extremely thin so any changes in blood circulation immediately become visible. Especially when you are tired the blood may contain slightly less oxygen in that area and is therefore darker in colour. Also chronic edema or swelling can lead to deposits of pigments within the skin. All these factors can be influenced somewhat by removing the excess skin and tightening the tissues, however it is unlikely for the dark rings to disappear completely. Sometimes good results can be achieved if additional lipofilling (fat grafting) is performed underneath the eyelid skin.
What happens if too much skin is removed?
If too much skin is removed, the edge of the eyelid will be pulled downwards and may prevent you from being able to close your eye completely. A gap between the upper and lower eyelid of a few millimeters can be absolutely normal immediately after surgery and in most cases settles completely over a period of 3-4 weeks. If the gap remains significant and causes discomfort such as a dry eye or increased tear production it will be necessary to re-open the surgical wound and correct the defect with a thin skin graft.
Can I wear make-up after the operation?
Once the wounds have healed completely (approximately 1 week after surgery) you can apply make-up freely. Before this time the wound itself should be kept clean and dry. You may apply make-up to the surrounding areas though.
Will I get a sick certificate for the time I am off work?
No. Sick certificates cannot be issued for cosmetic procedures. You will need to take leave for the entire period that you are absent from work.
Will my health insurance cover the costs for the surgery?
No. A midface lift is a purely aesthetic procedure which is not covered by health insurance.
Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?
Yes, provided the complication is purely medical, e.g. an infection. Corrections of aesthetic complications (e.g. asymmetry, scarring, under- or overcorrection etc. ) are not covered.