The shifting focus of facial aesthetics: Rise of the mid-facelift

Plastic surgeons have seen a recent shift in facial rejuvenation around achieving a truly youthful appearance. The mid-facelift is an increasingly popular, less intensive yet highly transformative procedure that offers natural, lasting results without the intense recovery of a traditional facelift.

So, what has been driving this shift towards mid-facelift popularity? How does this procedure differ from a traditional facelift? What should patients consider when planning a mid-facelift to maximize their chances of achieving the best possible results?

To answer these questions and gather more insights into facial aesthetics and the growing popularity of the mid-facelift, we reached out to ASPS Member Surgeon Nima Naghshineh, MD, MSc, FACS.

ASPS: While many patients may be familiar with the traditional facelift, fewer are as acquainted with the trending mid-facelift. How popular is this type of procedure at your practice?

Dr. Naghshineh: While the classic full facelift has long reigned as the gold standard in surgical facial rejuvenation, a more nuanced, targeted alternative is claiming the spotlight – the mid-facelift. Elegant in its subtlety and powerful in its precision, this procedure has been quietly transforming the aesthetic landscape, especially among patients seeking natural refinement over dramatic transformation.

In my practice, I've noticed a dramatic increase in the demand for alternative facial rejuvenation procedures, such as a mid-face, lower face or neck lift. Overall, patients are viewing these procedures as the "less aggressive," "less noticeable" and "more natural" option that still delivers powerful changes while preserving each patient's unique characteristics. When a patient comes to me and says, "I want to look refreshed, but I don't want anyone to know I've had anything done," our next chat may be about a mid-facelift.

ASPS: Who are the patients that typically approach you for a mid-facelift vs a traditional facelift?

Dr. Naghshineh: As the stigma of facelifts continues to dissipate, I have seen increased interest in mid-face and similar "focused" lifts from my younger patient demographics, such as those in their early 40s to 50s. Increasingly, individuals are gravitating toward procedures that offer meaningful results with a lighter touch.

The increased interest is also a sign of how patients are now much more educated on their options and often come to their initial consultation well-equipped to discuss the nuances of these options. The mid-facelift, lower facelift and neck lifts have surged in popularity, outpacing traditional full facelifts in frequency. In short, these techniques deliver refined, tailored enhancements that respect and preserve a patient's unique facial identity.

A full facelift is not without merit, however, and I still have patients, primarily those in their 50s to 70s, who still seek traditional full facelift procedures. These individuals are typically looking to address more advanced signs of aging. Interestingly, even this cohort often inquires about less-invasive techniques, demonstrating a broader shift in how patients approach facial surgery – as a bespoke journey, not a one-size-fits-all fix. The difference we see now among these patients is that they are also familiar with more focused lifts but seem to understand that a traditional facelift would best address their concerns.

ASPS: Are some patients better candidates for one procedure over the other?

Dr. Naghshineh: A mid-facelift is ideal for the patient experiencing early volume loss or descent in the cheek area, more noticeable nasolabial folds, and a general sense of looking "tired." It's a refined solution for individuals who may not yet exhibit significant skin laxity or sagging along the jawline or neck.

In contrast, the full facelift remains the definitive answer for those facing more extensive signs of aging. The traditional facelift patient often is looking to address excess skin and laxity along the neck, lower and upper face. In many cases, it provides volume repositioning and removal of excess skin that mid-face techniques alone cannot achieve.

ASPS: What are the inherent differences and commonalities in how these procedures are performed?

Dr. Naghshineh: Though often discussed in the same breath, the mid-facelift and full facelift are fundamentally different in both design and intent. In fact, one could perform both as they are virtually exclusive. The mid-facelift is a targeted approach, focusing primarily on repositioning the soft tissue of the cheek and malar regions. It's especially well-suited for patients seeking a subtle restoration of youthful contours, often without the need for volume augmentation through fat transfer or fillers. It does not do much in terms of addressing other areas of laxity or excess skin.

Meanwhile, traditional facelift procedures offer a more global transformation and significantly improve deep tissue laxity and excess skin of the face and neck. Notably, it tends to be less effective at repositioning cheek volume, leading many surgeons to combine it with fat grafting or adjunctive techniques to improve facial balance and combat soft tissue descent.

ASPS: What are the inherent differences and commonalities in the recovery processes and results of these procedures?

Dr. Naghshineh: Mid-facelift patients often enjoy a swifter recovery, with less swelling and bruising thanks to shorter, more discreet incisions. In contrast, a full facelift typically requires a longer downtime, with more noticeable postoperative swelling and more extensive incision sites.

Like with many procedures, the degree of swelling and bruising will vary based on the techniques used by the surgeon and whether complementary procedures, such as laser resurfacing or volume restoration, are done concurrently. Regardless of the path taken, both procedures offer transformative results when executed with artistry and precision.

ASPS: Do you have any advice or best practices for patients who are interested in pursuing a mid-facelift?

Dr. Naghshineh: The most successful outcomes come from patients who understand the scope of what each procedure can realistically deliver. Patients should understand that while a mid-facelift can be an elegant solution for specific concerns, it may not address broader facial aging. It can be combined with other procedures to address other concerns, but sometimes a traditional full facelift is needed.

The bottom line? Seek a board-certified plastic surgeon who not only offers a spectrum of surgical and nonsurgical treatments but also has the discernment to tailor a plan that aligns with each patient's anatomy, goals, and aesthetic vision.

ASPS: Are there any other insights around this topic that you'd like to share?

Dr. Naghshineh: I would be remiss not to acknowledge the ever-growing interest in nonsurgical options. While technological advancements in tightening and volumization have made nonsurgical rejuvenation more compelling than ever, it's important to manage expectations. For the right patient, these modalities can be extraordinarily effective. However, they are not substitutes for surgery. Ultimately, it's not about surgical versus nonsurgical – it's about matching the right treatment to the patient based on their specific concerns and the level of improvement they seek.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.