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Mid Facelift in San Francisco Bay Area, CA

A “mid facelift” was pioneered by Dr. Robert Aycock’s former business partner and colleague, Dr. E. Ronald Finger in Savannah, Georgia. The mid facelift is often performed in conjunction with a brow lift. As a board-certified plastic surgeon, Dr. Aycock has championed the unique procedure of the mid facelift to incredible results and has incorporated it into his San Francisco and Bay Area practices.

What Is a Mid Facelift?

The Transmalar Subperiosteal Mid Facelift with Minimal Skin and Superficial Musculoaponeurotic System Dissection: A Durable, Natural-Appearing Lift with Less Surgery and Recovery Time

Over the past several years, we have employed a procedure to elevate the mid-face using an approach developed and championed by E. Ronald Finger, MD, in Savannah, Georgia. I had the pleasure of being business partners with Dr. Finger for several years while I was in practice in Savannah. I have kept in close contact with Dr. Finger since my move to California and we frequently discuss our latest ideas in new ways to do the things that we enjoy most in plastic surgery. During one of my many trips to Savannah, Dr. Finger was in the early stages of development of what would become the transmalar subperiosteal mid facelift. After working with Dr. Finger on several of these procedures, we began slowly integrating this procedure into our practice here in California. Since that time, we have done many of these procedures and have been very happy with the results obtained with this addition to our facelift procedure. This procedure is often performed in conjunction with endoscopic brow lift procedures, where we use three small incisions in the scalp, instead of the old bicoronal incision from ear to ear across the top of the scalp.

The transmalar subperiosteal mid facelift is a procedure that we use in conjunction with our standard, deep plane facelift. The point of entry into the subperiosteal space is over the zygoma allowing for an easy approach to the periosteum to which the muscles of facial expression are attached. This is also in the area of maximum tension on the facelift so that less effort is needed to get the same amount of lift. This dissection is made through a small opening in the orbicularis muscle and periosteum. Using a periosteal elevator, the periosteum is easily elevated over the zygoma and out onto the zygomatic arch for the mid-face dissection. Once this blind dissection is completed, the mid-face is elevated and held in place by fixation using a non-absorbable stitch from the periosteum to the temporal fascia. There are many reasons for our using this approach: limited chance of ectropion because we do not use a lower eyelid incision, more lift in the area of the mid-face without excess tension because of the close proximity of the stitch to the point of maximum tension, no stigmata of “tight facelift” with a wind-blown look, and an easy approach without significant complication rate. In our procedure, the skin and SMAS are elevated only minimally for exposure and we feel this actually improves the appearance of the patient while allowing for a quicker recovery. Our goal in this procedure is to provide a younger, more rested look; while not leaving behind the tight, pulled, or stretched look. Through the skin incision, the SMAS-platysma flap is elevated to tighten the neck by rotation of this flap up to the mastoid process. This is held into place with absorbable suture. With less dissected tissue (one plane instead of multiple planes of tissue), the recovery is quicker because there is less swelling in the post-operative phase. In the past, many facelift techniques have been described. In recent years, there has been an emphasis on the middle third of the face. In performing facelifts, attention must be paid to the smallest of details since these can affect the final results. The original transmalar subperiosteal mid facelift was designed seven years ago to simplify the mid facelift with a more direct approach. In the past, this procedure has been done through the lower eyelid incision, through the buccal sulcus incision, and endoscopically. This more direct approach reduces the area of tissue dissected while yielding a natural-looking, safe, and equally stable lift.1 This procedure provides a natural look with none of the telltale signs of a facelift such as draping of the skin or that “wind-blown look.”

In this procedure, the boundaries of dissection for the mid facelift are the infraorbital rim lateral to the infraorbital foramen, around the infraorbital nerve to the nasal alar crease, then down over the lower part of the maxilla above the upper lip for approximately 1 cm. The lateral boundary is 1 to 2 cm over the masseteric fascia, and from there the direction is superiorly to about the middle of the zygomatic arch. The mid facelift is performed first then the SMAS (superficial musculoaponeurotic system), and this sequence is much better than the other way around. There is significant movement with the mid facelift requiring less elevation of the SMAS for the same amount of lift. There should be very little or no tension on the skin after the lift of the mid-face. This limited undermining of the skin and SMAS results in less swelling and bruising and quicker healing time. This is all done to improve the post-operative phase of the procedure and improve the final results while avoiding excessive undermining of the skin in the face. This dissection usually goes only out to the extent of the SMAS undermining. This limited undermining in the SMAS and skin has dramatically reduced the amount of post-operative swelling and bruising while providing a strong lift in the face and neck. More planes of tissue elevation cause more disruption of the arteries, veins, and lymphatics in each plane while compromising the layers above as well. Therefore, the more levels dissected, the more compromise there is to these systems. If all three layers are dissected to the maximum levels, the post-operative phase is full of increased bleeding, swelling, and risk such as skin necrosis. The mid facelift does not by itself increase swelling but increased levels of dissection will increase the morbidity of this procedure.

This procedure offers a simple and direct approach to improving our results in facelifts. We get a strong fixation of the zygomaticus muscles to the very strong temporalis fascia. Because of the avoidance of the lower lid in this approach there is less likelihood of ectropion and the lower lid can actually be enhanced by this procedure. This procedure requires less dissection than many described mid-face procedures; therefore, the complication rate is less and results are better. The elevation of periosteum also elevates the zygomaticus major and minor, levator anguli oris, and levator labii superioris and orbucularis oculi muscles. This gives a natural appearing result without the stigmata of the “wind-blown” or the tight facelift look. There is no excessive tightening of the SMAS or skin sutures to give draping or the lines from the lateral commissure of the mouth to the ear. The lower portion and the lateral portion of the periosteum are released to allow significant elevation over the maxilla. This extensive movement is demonstrated by the fact that even with extensive elevation of the SMAS, no significant improvement can be achieved after the mid-face has been secured to the temporalis fascia. This procedure adds about 10 minutes of operative time to each side, and a 7-year follow-up has demonstrated effectiveness and safety. Plastic surgery is constantly changing, and we as plastic surgeons are constantly trying desperately to keep up with these changes. This was one change that we made that proved to be both a pleasure to perform while giving a significant improvement to our facelift procedures from the past.

1.       Finger, E.R. Transmalar subperiosteal mid facelift: Technical modifications new suggestions and limitations. Aesthetic Surg. J. 18:222, 1998.

Benefits of a Mid Facelift*

The mid facelift is a great alternative to a more complex facelift, in that it provides the following benefits:

  • Concentrates on the jaw and brow area to provide a more relaxed appearance.
  • Reduces recovery time substantially and decreases swelling.
  • Gives you the appearance of younger-looking skin without any of the telltale signs of having had a facelift.

Preparing for a Mid Facelift

You may be asked to have lab testing or a medical evaluation done to rule out any external issues that may interfere with your surgery. You may also be asked to start, discontinue, or adjust your current medication schedule. You’ll recover more quickly if you stop smoking, and you should avoid taking aspirin, anti-inflammatory medicines, or any herbal supplements as these can increase bleeding.

Mid Facelift Recovery*

Because it disturbs fewer areas of the skin and musculature, a mid facelift has a shorter recovery time than a more traditional facelift. You will receive specific instructions on recovery time for your unique situation during your free consultation with Dr. Aycock’s office, as well as learn about the innovative procedures that can help you look your best!

How Much Does a Mid Facelift Cost?

The cost of a mid facelift in San Francisco varies depending on the extent of surgery needed. Dr. Aycock provides convenient financing options, including CareCredit®; to help cover the cost of your surgery, and you may be approved in as little as an hour. Visa®, MasterCard®, and Discover® are also accepted, and you’ll enjoy a FREE CONSULTATION on your first visit to our office.

Is a Mid Facelift Right for Me?*

A mid facelift may be the ideal procedure for you if you meet any of the following conditions:

  • You are concerned about the effects of aging on your skin, particularly the middle third of your face.
  • You want to avoid the draping, wind-blown look of traditional facial surgery while correcting fine lines and wrinkles.
  • You want all the benefits of facelift surgery without looking like you’ve gone under the knife.

Why Choose Dr. Aycock?

With over 25 years of plastic surgery experience, Dr. Aycock is a board-certified surgeon who has performed a number of both structural and cosmetic surgeries over the years. As one of the most awarded and trusted surgeons in the Bay Area, you can rest assured that Dr. Aycock will personally attend to your questions, comfort, and needs from the very first visit.

What to Expect During Your Consultation

Dr. Aycock will take the time to go over your complete medical history to ensure there are no conflicts or issues that could arise during or after your plastic surgery procedure. He will discuss your goals and anticipated outcome of your surgery, as well as answer any questions you may have. Depending on the type of procedure you plan to have done, he may examine the area being treated. Every consultation is done with the utmost professional courtesy and thorough explanation of each step to ensure that you are informed and comfortable with the process. Once you feel fully assured and satisfied with the answers, you can move forward with scheduling your surgery.

Additional Facial Surgery Options

A mid facelift is an innovative procedure available in few plastic surgery facilities. See the results for yourself and then contact our office to schedule your free consultation with Dr. Aycock’s office to learn what a mid facelift can do for you!

*The content of this website is intended to be general information. It is provided only as a service. It is not medical advice and not intended to be taken as medical advice. The content of this site should not be used to diagnose or treat a medical or health condition and is in no way meant to be a substitute for or delay the seeking of appropriate or professional medical care. Individual results may vary.