Midface Lifting: Can It Help When Midface Sagging and Hollowing Are Severe?

When looking in the mirror, you may notice that your nasolabial folds look deeper than before, while your front cheeks appear hollow and the area around your mouth feels heavier. It is easy to initially think this is simply due to reduced skin elasticity, but these changes may actually occur when the tissues located in the midface move downward.

The midface is the central area of the face. When this area sags, it can affect more than just the depth of the nasolabial folds. The three-dimensional appearance of the entire face may be reduced, and the areas around the mouth and jawline may also look heavier. Therefore, if you are considering midface lifting, it is important to first determine where the sagging began rather than focusing only on improving visible wrinkles.

What happens to the face when the midface sags?

When you are young, the tissues around the cheekbones and front cheeks are positioned relatively high, creating natural volume. Over time, however, as skin elasticity decreases and the forces supporting the tissues weaken, the cheek fat and soft tissues gradually move downward. This process may result in the following changes.

□ The front cheeks look flat or hollow

□ The nasolabial folds become deeper than before

□ Shadows develop below the cheekbones

□ The area around the mouth appears heavy and sagging

□ The deep cheek fat moves downward

□ The face looks longer and more tired

□ The jawline also becomes less defined

As shown above, midface sagging is not a change limited to one area; it can have a chain effect that extends to the lower part of the face.

Why filling only the nasolabial folds may not solve the problem

The area that people concerned about midface sagging tend to focus on first is the nasolabial folds. However, the reason these folds have become deeper may not simply be a lack of volume in that area. As the cheek tissue that was positioned higher moves downward, weight can accumulate above the nasolabial folds, making the boundary appear more pronounced.

In other words,

Descent of the front-cheek and midface tissues

→ Volume gathers around the nasolabial folds

→ The nasolabial folds appear deeper

→ The area around the mouth also feels heavier

In such cases, rather than taking an approach that only fills hollow areas, it is necessary to also examine the position of the descended tissues. In particular, if front-cheek hollowing, deep-cheek sagging, and lines around the mouth appear together with nasolabial folds, it is advisable to assess the overall aging pattern of the midface.

Midface lifting is not about “pulling as strongly as possible”

When people hear the term lifting, it is easy to assume that the stronger the upward pull on sagging cheeks, the better the result will be. However, in the midface, excessive traction can instead interfere with the natural facial contours.

If a face with a large amount of cheek fat is pulled upward too forcefully, the tissue may gather around the cheekbones, making them appear more prominent. Conversely, when the face is thin and lacks volume, certain areas may appear hollow, potentially making the overall appearance look sharper.

Therefore, what matters is not pulling strongly, but moving the necessary tissues in an appropriate direction. By preserving the three-dimensional appearance of the midface while distributing and repositioning the sagging tissues, it may be possible to achieve more natural facial contours.

The lifting direction should differ from person to person

Even when people have similar nasolabial folds and cheek sagging, their facial structures are all different. Some people have thin skin, while others have thicker skin. The amount of fat, the degree of cheekbone prominence, and the volume of the front cheeks also vary. Therefore, when planning midface lifting, the following factors should be considered together.

Skin thickness and elasticity

If the skin is thin, excessive tension may be burdensome. If the skin is thick or there is a large amount of fat, the weight of the tissue must also be taken into account.

Position of the front-cheek and deep-cheek tissues

The direction of traction can be determined only after identifying which tissues have actually descended.

Cheekbone structure

On a face with prominent cheekbones, moving the tissues excessively upward may make the cheekbones appear even more pronounced.

Left-right asymmetry

Because the degree of sagging is not exactly the same on both sides of the face, adjustments suited to each side are necessary.

If these factors are not assessed and a uniform technique is used, the resulting facial contours may differ from what was expected.

A greater number of threads does not necessarily mean a greater effect

When researching midface lifting, many people first compare how many threads are used. However, the result of thread lifting is not determined simply by the number of threads.

Using more threads than necessary or applying excessive force to a face with limited sagging may instead make the skin look uneven or cause facial expressions to feel unnatural.

Conversely, when the weight of the fat is substantial and sagging has progressed considerably, sufficient support may be necessary.

Therefore, what matters is not the number of threads, but

where the tissues will be supported,

which direction they will be moved in,

and how much appropriate tension will be applied.

These three factors are important.

It is important to place the necessary number of threads in appropriate locations according to each person's facial condition.

Anatomical understanding is especially important in the midface

The midface contains numerous anatomical structures, including nerves and blood vessels. In addition, different tissue layers, such as fat and fascia, are located beneath the skin, making the depth at which the threads are inserted important as well. If the threads are placed too superficially, they may be palpable through the skin or appear uneven. If they are placed in an inappropriate layer, it may be difficult to obtain sufficient support.

Therefore, midface lifting is not simply a procedure that pulls up sagging cheeks. It can be viewed as a process that requires an understanding of the internal facial structures and the selection of an appropriate layer and direction.

This is also why the judgment of a medical professional with experience treating various facial types is important.

Midface sagging does not simply mean that the nasolabial folds have become deeper. It is a change that can alter the overall impression of the face as the volume of the front cheeks moves downward and the deep cheeks and area around the mouth become heavier.

Therefore, if you are considering midface lifting, it is important to first determine which tissues have descended, by how much, and in which direction they should be moved to create a natural appearance, rather than trying to improve only one visible wrinkle.

Rather than focusing only on the number of threads or strong traction, consider whether the skin, fat, bone structure, and differences between the two sides have been sufficiently analyzed and whether a suitable direction can be planned accordingly.

| This post was written for informational purposes in compliance with Article 56, Paragraphs 1–15 of the Medical Service Act. All treatments carry the risk of side effects and complications, which may vary from person to person. Before undergoing treatment, be sure to have a thorough consultation with a medical professional with extensive experience before making a decision. |