Midface Lifting

The midface is the central third of the face that includes all the anatomical structures of the lower eyelid and cheek and is highly complex due to the great abundance of muscles, fat compartments, blood vessels and nerves. From a functional oculoplastic perspective, the main role of the midface is to provide support to the lower eyelid and protect the eye [1–9]. From a cosmetic standpoint, the eyelid-cheek junction is where many ageing changes related to volume loss and shift occur resulting in a tired, older look, hence the name “tear trough” [1, 2] . The eyelid-cheek junction is usually a soft and smooth transition that is located approximately 6–10 mm below the lower lid margin in a young face. With normal ageing, the tear trough gradually descends due to progressive laxity of the orbito-malar ligament and volume loss in the cheek below (Fig. 1). The decrease in cheek support with ageing leads also to stretching of the canthal ligaments, increased horizontal laxity and vertical sagging of the lower eyelid. This can lead to an increased MRD2 and inferior scleral show and in severe cases to eyelid retraction or ectropion [10–17].