Endoscopic midface lift in Thessaloniki and Athens, Greece

A midface lift returns the soft tissues between the lower eyelid and the corners of the mouth to their earlier position. It lifts the cheeks and softens the nasolabial folds and the tear trough by raising the deeper tissues vertically, without pulling on the skin. It is also called a cheek lift.

Ageing in the midface is not only a matter of skin. The fat compartments (fat pads) of the cheek shrink and slide downwards [1], and the ligaments that support them loosen. The result is a tired look under the eyes and deeper nasolabial folds. In some people this appears earlier, because of their anatomy.

The classic facelift used to pull mainly on the skin. Today we lift the deeper tissues and, when needed, fold them on themselves to add volume to the cheeks. With no tension on the skin, scars heal better.

When might a younger patient need a midface lift?

Some people have a weaker facial skeleton and flatter cheekbones that do not support the soft tissues well, so laxity shows even before 30. In these patients an endoscopic midface lift is corrective, not only anti-ageing.

Cheek implants are an alternative. An endoscopic lift uses your own tissues instead: they are raised towards the cheekbone (zygomatic arch) and strengthen the curve of the cheek, the ogee curve [2].

A midface lift usually suits people aged 30 to 55 whose cheeks have descended, who have a hollow under the eyes and who do not have much excess skin. If the laxity is mainly along the jawline and the neck, I recommend a deep plane facelift instead, or a combination of the two.

Preparation starts with a consultation, where I examine your face and we agree on the technique. Before surgery you need blood tests and, where needed, a heart check. You stop smoking 4 weeks before and 4 weeks after, and we review any blood-thinning medicines.

What happens at the consultation?

I examine the cheeks, lower eyelids, brows, jawline and neck, and check whether the laxity comes from descended fat or from excess skin. We decide whether the midface alone is enough or a combination is needed, and which technique suits you. You receive a written plan.

Tests and instructions before surgery

You will need blood tests and, where needed, a cardiology check. Stop smoking 4 weeks before and 4 weeks after surgery. If you take anticoagulants or antiplatelet medicines, tell me; you stop them only with the agreement of the doctor who prescribed them.

A midface lift is performed under general anaesthesia or local anaesthesia with sedation. The endoscopic technique takes 1.5 to 2 hours; the lower eyelid and temple routes take about 1 hour. In every technique the midface tissues are released from the ligaments that hold them low and secured higher, vertically.

The reason to lift the midface is the same for every technique. The choice depends on your overall goal and on any other procedures done at the same time. Because the tissues are released widely, they rise without tension on the skin. The movement is vertical, not backwards, so it does not give a “pulled” look. Skin usually does not need to be removed: it follows the new position of the tissues and adapts. If laxity is very advanced, I combine the operation with another technique, such as a deep plane facelift.

Which technique do I choose?

Technique	Access	When I choose it
Through the lower eyelid [5]	Through the lower blepharoplasty incision	The simplest option, when lower eyelid surgery is being done anyway
Through the temple [4]	Only through the temple hairline, with no incision inside the mouth	When the lower eyelid needs no surgery; can be combined with a canthopexy or a lift of the tail of the brow
Endoscopic [2–4]	Small incisions in the temple hair and inside the mouth, with a camera	When the forehead is also being corrected, together with an endoscopic brow lift

Endoscopic midface lift

An endoscopic midface lift is performed with an endoscopic camera in the subperiosteal plane, directly on the bone, where bleeding is minimal. In essence it extends the endoscopic brow lift so that it also includes the midface (extended endoscopic brow lift) [2–4]. The steps:

• Small incisions in the temple hair and inside the mouth.
• A fine high-definition camera (endoscope) lets me see clearly the nerves and structures that must be protected.
• Through the temple and the mouth I release the midface at the level of the periosteum (on the bone), from the ligaments that hold it low.
• I lift the tissues vertically and secure them with stitches to the temporal fascia or the periosteum, and less often directly to the bone through a small channel [2–4].

The precision of the work and the stability of the result over time are why I prefer it when the forehead is also being corrected. The endoscopic brow lift is described on the forehead and brow lift page.

Midface lift through the lower blepharoplasty incision

The midface can also be lifted through the lower blepharoplasty incision, just below the lashes [5]. It is the simplest option when lower eyelid surgery is being done anyway, and it takes about 1 hour. Compared with a facelift, the improvement is more limited. The advantage is that the incisions are minimal and become almost invisible after about 3 months. See also the blepharoplasty page.

Midface lift through the temple

When the lower eyelid needs no surgery, I lift the midface through a single incision at the temple hairline, with no incision inside the mouth [4]. It takes about 1 hour. Through the same incision I can lift the outer corner of the eye (canthopexy) or the tail of the brow, as in a mini temporal lift.

Incisions and stitches

The incisions are small and, depending on the technique, hidden in the hair, inside the mouth or just below the lashes. There are no incisions in front of or behind the ear.

• Endoscopic: incisions of 1 to 2 cm in the temple hair and inside the mouth. The scalp is closed with metal clips, removed after 5 to 7 days; the incision inside the mouth is closed with absorbable stitches.
• Lower eyelid: a non-absorbable buried (intradermal) stitch, removed on day 5.
• Temple: an incision exactly at the hairline, closed with an absorbable buried stitch that does not need removing.

The tissues are secured with stitches to the temporal fascia or the periosteum, and less often directly to the bone through a small channel. Because the skin is not stretched, the scars in the hair fade within 4 to 6 months.

Combining a midface lift with other procedures

To avoid an imbalance between the upper and lower face, a midface lift is often combined with other procedures:

Combined with	What it adds
Endoscopic forehead and brow lift	Lifts the upper face; controlled weakening of the frown muscles also softens the lines between the brows
Deep plane facelift	Jawline and neck, when laxity is more extensive
Fat transfer (nanofat, microfat)	Volume in the cheeks, the midface and around the eyes
Blepharoplasty (eyelid surgery)	Refreshes the eyes; corrects bags and excess skin, which a lift does not remove
Endoscopic mini neck and jawline lift	For younger patients, with small incisions and no incision around the ear

In many facial operations I add nanofat: fat from your own body, prepared as a very fine graft, which improves skin texture [6]. I use it as a complement and rarely on its own, because fat survival is not predictable.

Do I need to stay in hospital?

No hospital stay is needed: you go home the same day with someone to accompany you. If thin drains are placed, they are removed after a few hours. You must not drive on the day of surgery after the anaesthetic.

Pain is mild. In the first week there is mild to moderate swelling and possibly mild bruising. Most people return to social and work life after 10 to 12 days. Swelling settles gradually over 3 to 6 months, and the final result shows at 12 months. Recovery is the same for all three techniques.

If a brow lift is done at the same time, you may have a mild headache for the first few days. Bruising is minimal; moderate bruising of the upper eyelids is rare. When you go back to work, a little make-up may help.

When	How you feel	What you can do
Day of surgery	Mild pain; possibly a mild headache if a brow lift was also done	Go home with someone to accompany you; thin drains, if used, come out after a few hours; rest with your head raised
Days 1–4	Mild to moderate swelling, possibly mild bruising	Cold compresses and ordinary painkillers; rest and gentle walking
Days 5–7	Swelling starts to settle	Endoscopic: metal clips removed from the scalp and first hair wash · lower eyelid: stitch removed on day 5 · temple: absorbable stitch, no removal
Days 10–12	Mild swelling remains under the eyes and in the cheeks	Back to social and work life, with a little make-up if needed
Weeks 2–4	Swelling keeps going down	Light exercise after 2 weeks, strenuous exercise after 4
Months 3–6	Swelling settles gradually; scars in the hair fade over 4–6 months	Normal activity; laser resurfacing, if we have planned it
Month 12	Final result	Review at your follow-up

Plan to stay in Greece for about 5 to 10 days after a midface lift. You go home from hospital the same day, so the stay is mainly for your check-ups and for stitches or clips to come out. I usually advise waiting until at least day 5, and until the clips or stitch are out, before you fly.

You do not stay overnight in hospital; you rest at your hotel or apartment the same evening, with someone to accompany you. Timing then depends on the technique. After the endoscopic technique the metal clips in the scalp come out after 5 to 7 days. After the lower eyelid route the stitch comes out on day 5. After the temple route the stitch is absorbable and does not need removing. I see you in person for the clip or stitch removal and for a final check the day before you travel.

After you return home, follow-up continues by video call at 10 days, 1 month, 6 months and 1 year, and you can send me photos at any time if something worries you. Before you travel, arrange for someone to be with you for the first days at home, cold compresses, ordinary painkillers and a pillow to keep your head raised. Most people are back at work 10 to 12 days after surgery, so plan your time off around that.

The improvement after a midface lift is long-lasting, because the tissues are secured in their new position. Your face looks more rested, without changing your features or your expression. Ageing continues, but from a younger starting point. The final result shows at 12 months, once all the swelling has settled.

I aim for subtle, natural changes that keep the harmony of the face; your expressiveness is preserved. How much is corrected always depends on your anatomy and your preferences. Unlike non-surgical lifting methods such as threads, the result is stable for many years. In a cheek and neck lift, provided your weight stays stable, I expect the result to last 15 to 20 years. Laser resurfacing can enhance the result, because it improves the fine surface lines around the mouth.

Like any operation, a midface lift carries risks. The main ones are temporary weakness of the forehead or the smile, asymmetry, prolonged swelling and numbness. They are more common with the extended endoscopic technique and in most cases settle. I explain the risks for your own case at the consultation.

Complication	How common	Prevention and management
Swelling and bruising	Common, temporary	Cold compresses, head raised; swelling settles over weeks
Prolonged swelling in the cheeks and under the eyes	Not rare, mainly with the extended endoscopic technique	Settles gradually over 3–6 months
Numbness of the cheeks or scalp	Common, temporary	Usually recovers within weeks to months
Temporary weakness of the forehead or the smile	Rare, temporary	The camera lets me see and protect the nerves; settles within days to weeks
Asymmetry	Rare	Assessed once swelling has settled; a small correction is rarely needed
Hair loss at the incision	Rare, usually temporary	Incision with no tension on the skin; with the temple technique the incision is at the hairline
Change in lower eyelid shape (lower eyelid technique)	Rare	Support of the eyelid with a canthopexy where needed
Haematoma (hematoma) or infection	Rare	Review of medicines that affect clotting, antibiotics; treated promptly

Smoking. Stop at least 4 weeks before and 4 weeks after surgery; smoking increases healing problems and reduces the success of fat transfer.

Blood thinners. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

We do not publish prices, because the cost of a midface lift differs from person to person. It depends on the technique, the length of the operation and whether it is combined with other procedures. You receive a written quote after your consultation, once I have examined you and we have agreed on your plan.

• The technique: endoscopic, through the lower eyelid or through the temple.
• The anaesthesia: general, or local with sedation.
• Combination with a brow lift, blepharoplasty, canthopexy or deep plane facelift.
• Fat transfer (nanofat, microfat), if needed.
• The hospital: Thessaloniki or Athens.

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