The midface, or the cheeks, is a prominent place where we demonstrate aging. Over time, fat pads in our cheeks shrink in size and descend lower in our faces leading to a deflated, haggard appearance. To make matters worse, age related changes of the midface accentuates aging of neighboring regions such as the lower eyelids and lips. For instance, as the fat pads in the midface fall away from the lower eyelid fat pads, a crescent shaped depression can form between the two. Furthermore, as the cheek fat descends, it settles along the nasolabial fold, the fold that extends from both sides of the nose to the corners of the mouth. This causes deepening of the fold, further causing insult to injury. 

 

To address this issue, several midface lifting techniques have been implemented to combat this issue. Nevertheless, lifting of the midface more often leads to a stretched and pulled appearance rather than a rejuvenated look. In addition, the eventual sagging of the midface fat pads often recur as short as 2-3 years after the procedure, leading to high rates of revision surgery. With this in mind, a new paradigm shift emerged in treating the aging midface: the addition of volume rather than lifting is the key to natural rejuvenation. 

 

Volume augmentation of the midface is achieved primarily with nonsurgical measures such as the injection of dermal fillers and surgical measures such as implant placement and fat transfer. The injection of long lasting fillers such as calcium hydroxyapatite (Radiesse) are first line treatments for nonsurgical volumization of the midface with effects lasting up to 18 months. This is ideal for those wishing to avoid surgery and “dip their toes in the pool.”  Midface implants are typically composed of inert polymers such as silicone that are inserted through small incisions near the gums, hence avoiding the need for an external incision. The implant is tapered at the edges to allow it to blend in with the underlying bone, making it difficult to detect even to the touch.  Meanwhile, fat transfer involves harvesting fat via small incisions from the flanks, abdomen or thighs, with subsequent injection into the midface. Each of these modalities offer safe, natural and predictable volumization of the midface.