Midface Lift Surgery

The midface — the area encompassing the cheekbones, lower eyelid, and the soft tissue beneath — is one of the first regions of the face to show meaningful aging changes. As we age, the deep fat compartments of the midface gradually thin, the supporting retaining ligaments stretch, and the malar fat pad descends from its earlier higher position. The result is a flatter, more tired-looking midface, deepening of the nasolabial folds, and the appearance of hollowing beneath the lower eyelid. A midface lift directly addresses these changes by repositioning the descended midface tissue back to its more youthful anatomical location — restoring the rounded, lifted contour of a younger midface rather than adding volume on top of the descent. A midface lift is one of the surgical options within facelifts and facial rejuvenation at Dr. Khosh’s Park Avenue practice in New York City.

Midface lift surgery is one of the most three-dimensional procedures in facial plastic surgery — the surgeon must visualize and reposition tissue that sits beneath the cheekbone and behind multiple layers of overlying anatomy. Dr. Maurice Khosh has spent three decades developing this technique across the spectrum of facelift surgery. A Clinical Assistant Professor at Columbia University and dual board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology–Head and Neck Surgery, Dr. Khosh was the youngest recipient of Columbia University Medical Center’s Maxwell Abramson Resident Teaching Award. A Fellow of the American College of Surgeons (FACS), he has been recognized as a perennial Castle Connolly Top Doctor.

The Anatomy Behind a Midface Lift

The midface is supported by a specific set of anatomical structures — primarily the zygomatic and zygomatic-cutaneous retaining ligaments, which anchor the cheek tissue to the underlying bone. With age, these ligaments stretch, the malar fat pad descends, and the suborbicularis oculi fat (SOOF) thins. Each of these changes contributes to the visible signs of midface aging. A midface lift addresses these layers directly rather than masking them. The procedure repositions the malar fat pad and surrounding soft tissue back to its earlier higher position, providing structural support to the cheek without adding volume that was never present to begin with.

What a Midface Lift Addresses

A midface lift is most effective for patients whose primary aging concerns are concentrated in the midface region. Common indications include:

• Descended Malar Fat Pad: Visible drooping of the cheek tissue from its earlier, higher position
• Deep Nasolabial Folds: Folds that have become more prominent as the supporting cheek tissue has fallen
• Tear Trough and Under-Eye Hollowing: Hollowing beneath the lower eyelid that has emerged because the cheek no longer supports the lid contour
• Flattening of the Cheekbone Contour: Loss of the lifted, three-dimensional projection of a youthful midface
• Lateral Cheek Descent: Sagging at the outer cheek that affects the overall midface harmony
• Early Jowl Development: Lower-face heaviness that has emerged because the midface no longer holds the surrounding tissue up

Patients whose primary concerns are in the lower face and neck — substantial jowls, neck laxity, or platysmal banding — are typically better served by a full facelift or neck lift, sometimes in combination with a midface lift. Dr. Khosh evaluates each patient honestly to determine the right scope of intervention.

Surgical Approaches to the Midface Lift

Several techniques can effectively reposition the midface. The right approach depends on the patient’s anatomy, the degree of descent, and whether other procedures are performed simultaneously:

• Endoscopic Midface Lift: Performed through small incisions hidden in the temporal hair, using endoscopic visualization to access and reposition the deep midface tissue with minimal scarring
• Transconjunctival Midface Lift: A midface lift accessed through the inside of the lower eyelid, often combined with lower blepharoplasty for comprehensive periorbital rejuvenation
• Subperiosteal Midface Lift: An approach that repositions the midface tissue at the level of the bone, often producing the most lasting and substantial elevation
• Suture-Suspension Techniques: Less invasive options for patients with mild descent who do not require full surgical repositioning
• Combined Approaches: Midface lifts are often performed alongside blepharoplasty, brow lift, or facelift for a comprehensive rejuvenation plan

“The defining decision in midface lift surgery is which plane to operate in — and how deeply to release the retaining ligaments. The more anatomical the release, the more durable the result. Three decades of facelift surgery have taught me that the patients who are most satisfied with their midface lift years later are the ones whose surgery addressed the underlying anatomy, not just the surface.” — Dr. Maurice Khosh

What to Expect from the Procedure

A midface lift is typically performed under general or twilight anesthesia in an accredited surgical facility. The procedure usually takes one and a half to three hours depending on the approach and whether it is combined with other procedures. Patients return home the same day with detailed care instructions. Most experience moderate swelling and some bruising for the first two weeks, with most bruising resolving within ten to fourteen days. Patients are generally able to return to work and social activities within two to three weeks, with strenuous activity avoided for three to four weeks. The final contour becomes visible as the tissues fully settle over the following several months, with results that typically last many years.

Why Patients Choose Dr. Khosh for Midface Lift Surgery

• Three Decades of Midface Surgical Experience: Thousands of facelifts performed across the full anatomical spectrum
• Clinical Assistant Professor at Columbia University: Active academic role at one of the country’s leading medical institutions
• Maxwell Abramson Resident Teaching Award: Youngest recipient at Columbia University Medical Center
• Dual Board Certification: Combined facial plastic and head and neck surgery expertise
• Park Avenue Convenience: Private Upper East Side practice serving patients from across Manhattan and the tri-state area

Schedule Your Consultation in Manhattan

If midface descent has changed the proportions of your face — softening the cheekbones, deepening the nasolabial folds, or producing hollowing beneath the eyes — a midface lift may be the targeted surgical solution. The first step is a thorough evaluation of the underlying anatomy and an honest conversation about whether a midface lift alone, or in combination with other procedures, will produce the result you are seeking. To schedule a consultation with Dr. Khosh at his Park Avenue office in New York City, call (212) 339-9988 or contact us online to request an appointment.