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Procedure: Mid Facelift (Endoscopic)

Mid Facelift (Endoscopic)

Endoscopic Subperiosteal Face Lift

THE GOAL: To tighten and reposition sagging tissues in middle third of the face causing a "drawn-out", tired, aged or angry appearance.


A number procedure variations fall under the rubric of 'face lift'. To clarify:

  • Face lift (rhytidectomy) is the classic term for a lower face lift, involving the lower third of the face only plus the neck. It includes recontouring the underlying structure by removing excess fat and tightening sagging muscles, followed by redraping of the skin.
  • Mid-face lift (subperiosteal face lift) refers to the middle third of the face, that is, the area around the nose, beneath the eyes and around the mouth. This state-of-the-art operation is performed through a small 2 cm incision made behind the each temporal hairline and within the mouth; it is made possible by the use of an endoscopic (and microscopic) camera to guide the specialized curved instruments used by the surgeon.

The purpose is to elevate rather than tighten or stretch the total soft tissue mass of the cheek, upwardly shifting the cheek fat pads that give the face its youthful shape and volume. Results are extremely natural and long-lasting. The above can be performed individually or at the same time as other procedures. Patients may choose to have a face lift in conjunction with other rejuvenating procedures such as a brow lift, eyelid surgery, lip reshaping surgery (e.g. upper or corner lip lifts), fat transfer or nose reshaping. Indeed, Dr Haworth may sensitively recommend these if he feels it appropriate.

A mid-face lift:

  • Elevates the sagging cheek mass back onto the cheek bones proper where they originally were in youth.

    Those patients with flatter cheek bones tend to manifest drooping cheeks sooner than those with "strong" cheek bones. When the cheek fat sags it accumulates around the level of the nasal tip especially noticeable from a 3/4 or oblique view, imparting a "drawn-out", tired appearance.
  • Recreates higher, more glamorous cheekbones by lifting the malar fat pads onto the cheek bones which are postioned laterally.
  • Reshapes the total face into a young heart- or diamond-shape which is inherently shorter in appearance than an older, more rectangular-looking face.
  • Rejuvenates the lower eyelid by restoring the malar fat pads to their proper position against to the lower eyelid rim, thus reducing any hollow look (often referred to as "tear troughs") that may have deepened over time. Dr Haworth may feel that additional procedures of fat transfer along with a lower blepharoplasty would complement the midface lift in an elegantly synergistic fashion. Refer to the eyelift procedural section for more details.
  • Elevates the lateral end or tail of the brow to minimize hooding of the outside aspect of the upper eyelid. Dr Haworth may customize his internal surgical maneuvers during the endoscopic midface lift in order to achieve this effect.

Close-up view of patient 4 years after midface lift and lower blepharoplasty



  • Improves the shape of the lower eyelid especially if it appears sad or droopy at its outer end exposing excess white of the eyeball. This situation may be congenital or an unfortunate result of past eyelid surgery. Dr Haworth may customize his internal surgical maneuvers during the endoscopic midface lift in order to improve this look so that more almond-shaped eyes are created.

One year after midface lift and rhinoplasty



  • Elevates the oral region, albeit in a subtle manner. Dr Haworth supplements his midface lift with a small unique technique to elevate not only the upper lip and its corners, but also the lower lip to help cover the lower teeth. The upper force of the cheek lift partially transfers onto the lip complex including its corner and lower end.

The most likely candidate for a mid-face lift

  • is 33 years old or older
  • is a patient who notices sagging around the nose, eyes and corners of the mouth but yet is not yet ready lower face lift surgery
  • is a patient who feels that their midface is too long and their cheek bones rather flat. He or she may also complain that their lower eyes look hollow and that they have extra tissue accumulating around their nasolabial folds.
  • is an older patient who wishes to have the mid-face rejuvenated in conjunction with a lower face lift and/or brow lift

What a mid-face lift cannot do on its own is:

  • Correct loose skin in the neck or significantly firm a jawline
  • Reduce jowling
  • Completely eliminate naso-labial folds or eyelid hollows
  • Restore contour, definition and volume to the lips

Old Thinking vs. New Techniques

Dr. Haworth is world renowned for his endoscopic mid-face work and has performed them throughout the globe. In general, mid-face lifts have become significantly more sophisticated than in generations past, resulting in more natural yet dramatic and long-lasting outcomes than ever before. These breakthroughs include:

  • EARLY ALTERNATIVE : It's not unusual for the middle third of the face (measured from the lower eyelids to the corner of the mouth) to age sooner than the lower face. Signs of this process include sagging cheek fat with pronounced nasolabial folds, loss of cheek bone height, hollow lower eyelids and an eleongated face. A mid- facelift can address these changes without the patient having to go in for a classic face lift with its attendant, potentially visible scars.
  • ENDOTINE MIDFACE™ ST: Dr. Haworth has been using Endodine technology for mid-face lifts for over six years with superb results surpassing those achieved with sutures. Manufactured by Coapt Systems Inc., Endotine systems represent a real breakthrough in soft tissue repositioning and healing. In short, Endotine are rapidly imperceptible tined implants that secure soft tissue in place of interior suturing. This means little to no trauma to the surrounding tissue, faster surgery time, faster healing, smoother healing and virtually no scarring. Even more extraordinary, the material itself is bioabsorbable meaning that as the tissue securely heals in its new position, the implant itself gradually and safely reabsorbs into the body, leaving no traces of itself behind.
  • ENDOSCOPIC MICRO-INCISIONS: The advent of endoscopic techniques (enlisting tiny cameras and elongated narrow instruments) have enabled plastic surgeons to carry out the mid-face lift through the smallest incisions above the hairline and inside the mouth. This results in far less scarring and a far quicker recovery.
  • ADDED BENEFITS: Dr Haworth is an expert in detailed, unique endoscopic tissue release to harness the maximum potential of the midface lift. He can not only lift the cheeks, but also alter the shape of the eye, affect the appearance of the mouth and influence the arch of the brow through the 4 hidden incisions


A mid-face lift can deliver a smooth, fresh, rejuvenated look that will last for years. However, as time goes by and gravity takes its toll, patients may want to have subtle revisions done down the road. Eventually, a classic facelift will be needed when significant jowls and an aging neck will be of particular concern. Refer to the facelift procedural description for further details.


Conditions that make a face lift more of a challenge and may require additional consent from the appropriate medical specialist include:

  • serious health issues such as diabetes, uncontrolled high blood pressure, heart disease, collagen vascular disease
  • blood clotting problems
  • the tendency to form excessive scars
  • smoking
  • ongoing dental decay


No surgery is entirely risk-free. However, both our staff and facilities have the highest possible qualifications to produce a happy outcome. While risks and complications are extremely rare, be aware that those for a mid-face lift can include:

  • Hematoma
  • Nerve injury
  • Infection
  • Poor healing

All of the above are extremely unlikely in this type of surgery.

Pre-op consultation

The pre-operative consultation is where you meet with Dr. Haworth and our staff to review your health, finalize the details of your procedures, order appropriate tests, prescribe medications, discuss your aftercare and answer any questions you may have. All patients are required to take a blood text a few days before surgery, which you can do at the same time as your pre-op consultation. All patients are required to take standard blood tests within 6 weeks of surgery.This can be arranged at the same time as your pre-op consultation. To the consultation, we ask that you bring the following if possible:

  • Any appropriate health records related to the list of conditions noted above.
  • Photographs of you when you were in your teens, twenties and thirties

For patients over 45, we may also require that you provide the following:

  • full medical clearance
  • EKG

Alternatively, we can coordinate this for you.

Critical Pre-Op Cautionary Note

It is absolutely essential that that you avoid all aspirin, aspirin-related, ibuprofen or blood-thinning medications for 2 full weeks prior to your surgery. In your pre-op consultation, we will give you a complete list of these drugs. For our patients, we also provide a password-protected link allowing you to download the list onto your computer. If in doubt about a specific medication, do not take it, call the office first and ask if it is on the forbidden list.

If your hair is very short, you might want to let it grow out before surgery, so that it's long enough to hide the scars while they heal.

Logistics and specifics


ANESTHESIA: General or sedation ("twilight sleep") we will do everything we can to keep you comfortable. An anti-emetic (against nausea) medication is also administered while you are asleep. We not only provide pain medication to control what little pain you may experience postoperatively, but you will be additionally prescribed anti-anxiety, anit-nausea and sleeping pills to maximally ensure your comfort and safety

SUTURE OR STAPLE REMOVAL: 3-5 days after surgery. As you wake up from surgery, your face will be exposed while your head will be wrapped. There will be 1 drain which will removed the next day and you should be in minimal pain. You may feel stiff when smiling or mouthing your mouth. However, prescription painkillers should easily control any discomfort.

Post-op care

You' will need to keep your activities to a minimum for at least 3 days. The worst swelling appears and retreats at postoperative day one and three, respectively.

In person and in your post-op information packet, we shall explain everything you need to know for your aftercare at home that will include:

  • Medications (prescription and homeopathic)
  • Cleaning incision sites
  • Activity limitations

During healing, you may experience:

  • Minor bruising
  • Stiffness
  • Numbness
  • Swelling. This, unlike after a classic facelift, can be quite significant but is usually short-lived.It peaks around the second day after surgery and subsides rapidly for the next 10-14 days. Most patients are looking acceptable 2-3 weeks after surgery and great 5-6 weeks postoperatively.
  • Subtle asymmetries

For the next few weeks, expect to tire easily. To aid your recovery you'll want to rest as much as possible and:

  • Treat your face and hair gently, since your skin will be both tender and numb
  • Ice your face every few hours for 2 days following your surgery
  • Keep your head gently elevated (above the level of your heart), even while sleeping
  • Avoid strenuous activity - including exercise, heavy housework - for at least 2 weeks. Abstain from sexual activity for a week and when you do resume it, commence gradually and rather passively.
  • Avoid steam baths, and saunas longer than 5 minutes for at least 6 weeks or until the doctor gives you the OK
  • Avoid alcohol and aspirin products for 2 weeks
  • If you don't feel dizzy, slow walking and mild stretching are fine as long as you do not bend over

To optimize and accelerate healing, we also recommend coming into the office for hyperbaric oxygen treatments and Bioptron™ polarized light therapy. Both of these modalites can reduce swelling and bruising by up to 5-7 days. Addtionally, these exhibit signicant healing properties upon slow-healing incisions and injured skin.


By the third week, you'll look and feel much better. Most patients are back at work about two to three weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.
Gradually, you will be able to resume to your normal activities:

  • 1-3 DAYS - read or watch television
  • 7 DAYS - resume wearing makeup (most bruising will be gone).However, you will most likely still be quite swollen for another week or so.
  • 14-21 DAYS - be out in public, back to work and take long strolls
  • 3-4 WEEKS - begin moderate and work up to vigorous exercise.

Minimizing scars

Scars resulting from a midface lift are hidden and generally present zero problems..