What Is a True Midface Lift? Why Some Facelifts Do Not Fully Correct the Cheeks

Facial rejuvenation is not simply about pulling or cutting skin. It is about anatomical restoration: precise, safe, natural, and discreet. In this Ponytail Facelift case, Dr. Chia Chi Kao demonstrates what he describes as a true midface lift: elevated and supported cheeks, a smoother lower eyelid-cheek junction, softer nasolabial folds, a more defined jawline, and a refined neck without an obviously operated appearance.

10–12 Minute Read

A true midface lift surgically elevates and stabilizes descended cheek tissues, improving the relationship between the lower eyelid, cheek, and nasolabial fold. Unlike procedures that focus primarily on the jowls and neck, a midface lift directly addresses central facial descent rather than relying on skin tension or filler alone.

Dr. Kao uses the term “true midface lift” to describe a result in which the cheeks are not merely pulled from the side. Instead, the descended facial tissues are repositioned, supported, and integrated with the eyelids, jawline, and neck to create a more balanced form of facial rejuvenation.

What Is a True Midface Lift?

A true midface lift elevates and supports the central face, particularly the cheeks, lower eyelid-cheek junction, and tissues contributing to the nasolabial folds. The goal is to restore cheek position and stability rather than simply tighten the skin.

Many patients think of a facelift as a procedure that sharpens the jawline, removes loose skin, and improves the neck. While those changes are important, they do not always fully correct the central face. The cheeks may still look low, heavy, or unsupported. The under-eye area may remain hollow. The nasolabial folds may remain prominent.

For Dr. Chia Chi Kao, a true midface lift is not simply about moving skin. It is about restoring the cheek to a higher, more stable, and better-supported anatomical position.

Before surgery, descended cheek tissue may feel loose, mobile, and easy to pull or distort. In this patient, Dr. Kao observed substantial cheek mobility and laxity before surgery. At the six-month follow-up, the cheek tissues appeared elevated, supported, and more stable.

That is the distinction between a procedure that primarily tightens the lower face and one that attempts to restore the architecture of the central face.

Why Some Facelifts Do Not Fully Correct the Midface

Some facelift techniques are designed primarily to improve the jowls, jawline, and neck. Because the midface contains different anatomical planes, support structures, and delicate nerves, cheek descent and the lower eyelid-cheek junction may require additional or differently directed elevation.

One of the biggest misconceptions about facelift surgery is that every facelift improves the cheeks equally. Traditional SMAS and deep-plane facelift techniques are often approached from the side of the face. This can be highly effective for lateral laxity, jowls, jawline definition, and neck contour.

The central face, however, is anatomically more complex. It contains delicate structures, important nerves, and deeper support systems that must be treated carefully. Because of this, some facelift procedures may improve the lower face while leaving the cheeks, lower eyelid-cheek junction, or nasolabial folds less corrected.

A patient may therefore notice a sharper jawline after surgery while the center of the face still appears tired, flat, or under-supported.

This is where Dr. Kao’s Ponytail Facelift approach differs. The objective is not simply to pull the face tighter. It is to restore the facial framework, including the midface, where aging can be highly visible and technically difficult to correct.

Understanding Cheek Laxity

Cheek laxity is excessive mobility, looseness, or descent of the cheek’s soft tissues, including the malar fat pad and its supporting structures. It may contribute to lower-eyelid hollowing, deeper nasolabial folds, lower-face heaviness, and a less defined jawline.

Over time, gravity, aging, volume loss, and changes in facial support can cause the cheeks to descend. When this happens, the entire face may appear heavier.

The cheeks no longer sit in their youthful position. The lower eyelids can appear more hollow. The nasolabial folds deepen. The corners of the mouth may appear pulled downward, and jowls become more visible.

In the video, Dr. Kao demonstrates that before surgery, this patient’s cheeks were droopy, lax, and easy to move. The cheek fat pad had descended, and the aesthetic units of the face had shifted downward.

At six months after surgery, the cheek appeared elevated, supported, and more stable. In Dr. Kao’s assessment of this patient, that improvement in stability was one of the clearest signs that the midface itself had been corrected rather than merely tightened from the side.

Cheek Descent and Nasolabial Folds

A midface lift may soften nasolabial folds when cheek descent contributes to their depth. It does not necessarily erase the folds, and the degree of improvement depends on facial anatomy, skin quality, volume loss, and the amount of tissue descent.

The nasolabial folds are the lines that extend from the sides of the nose toward the corners of the mouth. These folds often become more prominent as the cheeks descend.

Many patients attempt to treat nasolabial folds with filler. In selected cases, filler may soften the crease. However, filler does not reposition descended cheek tissue.

When the cheek pad moves downward, it creates heaviness above the fold. The fold becomes deeper not only because of volume loss, but also because the soft tissue has shifted.

A true midface lift addresses this contributing cause by elevating the cheek and restoring support. Rather than simply filling the crease, the operation attempts to improve the anatomical relationship that made the fold more prominent.

In this patient, one of the important postoperative observations was that the nasolabial folds appeared softer after the cheeks were elevated and stabilized.

Why the Under-Eye Area Ages With the Midface

The lower eyelid-cheek junction is closely connected to the midface. When the cheeks lose support, the under-eye region may appear more hollow, dark, or tired even when the eyelid itself is not the only source of aging.

This is why some patients believe their eyes are the main problem when the deeper issue also involves a loss of cheek support beneath the eyes.

For this patient, Dr. Kao identified under-eye hollowing, pigmentation, cheek laxity, and shallow structural support in the midface. The treatment plan therefore included customized tear trough implants to improve the lower eyelid-cheek junction.

Tear trough implants can provide structural support beneath the eyes. In this case, the implants were modified carefully to avoid making the cheeks appear excessively wide while still improving the hollow area below the eyes.

This type of correction contributes to a more natural result because the eyes, cheeks, and midface must work together. If one region is treated while the adjacent anatomy remains unsupported, the outcome may appear incomplete.

The Patient’s Story

This patient found Dr. Kao in an unexpected way. While at her dentist’s office, she noticed another woman whose face appeared naturally rejuvenated. The dentist asked the woman who had performed her surgery, and she named Dr. Kao.

After hearing additional positive feedback, the patient scheduled a consultation.

Her main concerns included:

• Cheek descent
• Jowls
• Neck laxity
• Under-eye hollowing
• Marionette lines
• Nasolabial folds
• Loose neck skin and visible bands

Most importantly, she wanted her cheeks lifted. She wanted the face to move upward rather than simply backward.

That distinction matters. Pulling tissues laterally without respecting the patient’s anatomy can contribute to distortion. Repositioning the descended tissues in a more anatomically appropriate direction may create a more natural and balanced appearance.

Dr. Kao’s Surgical Plan

The treatment plan was designed to restore support across the eyes, cheeks, lower face, jawline, and neck while preserving the patient’s natural brow position and facial identity.

The customized plan included:

• Maintaining her natural brow position
• Upper-eyelid redraping
• Lower eyelid-cheek junction correction
• Customized tear trough implants
• True cheek elevation
• Nasolabial fold improvement
• Jowl correction
• Neck skin tightening
• Platysmal band correction
• Submandibular gland refinement
• Jawline definition

Her brow position was already favorable, so the plan was not to over-lift the brow. This is an important part of natural facial rejuvenation. Not every feature needs to be elevated or exaggerated. The goal is proportion and harmony.

The upper eyelid was treated with redraping rather than aggressive excision. The lower eyelid-cheek junction was supported with customized tear trough implants. The cheeks were lifted to improve laxity and restore facial balance.

The neck was also addressed because facial rejuvenation may look incomplete when the jawline and neck do not match the refreshed midface. For selected patients, combining cheek support with neck lift refinement can create a more cohesive result.

What Makes This a “Home Run” Result?

Dr. Kao describes this result as a “home run” because it achieved multiple anatomical and aesthetic goals without an obviously operated appearance.

In his assessment, a successful comprehensive result may include:

• Natural brow shaping without conspicuous brow scars
• Upper-eyelid redraping rather than excessive tissue removal
• Structural support for under-eye hollowing
• Meaningful elevation and stabilization of the cheeks
• Improvement in buccal-jowl descent
• A longer and leaner-looking neck
• A more sharply defined jawline
• Incisions that are not readily apparent in the postoperative views
• No obvious hairline distortion
• No pronounced tightness or facial distortion

When these elements are achieved together, the result is not simply younger-looking. It appears balanced, harmonious, and consistent with the patient’s identity.

Her Six-Month Results

At six months after surgery, the patient showed improved cheek support, softer nasolabial folds, a smoother lower eyelid-cheek transition, a more defined jawline, and a more refined neck.

Her cheeks appeared elevated and supported. The degree of mobility and laxity demonstrated before surgery was no longer apparent in the postoperative assessment.

Her nasolabial folds appeared softer. Her jawline was sharper, and her neck appeared smoother and more defined.

In the views shown, the incisions were not readily apparent, and the result did not display obvious tightness, hairline distortion, or an unnatural brow position.

When asked what people said after her surgery, she explained that they believed she simply was not aging. They told her she looked good, but they did not identify one obvious surgical change.

That is the objective of discreet facial rejuvenation.

People should not focus on the procedure. They should see the patient.

Why Facial Harmony and Discreet Healing Matter

For many patients, the fear of looking “done” is one of the main reasons they hesitate to undergo facial rejuvenation. They worry about visible scars, distorted features, unnatural brow position, excessive tightness, or a pulled appearance.

Dr. Kao evaluates his results according to whether the face appears anatomically restored without conspicuous surgical stigma. In his view, a technically successful operation should not depend on overt tightness or distortion.

Natural facial rejuvenation depends on harmony among the brows, eyes, cheeks, jawline, and neck. A tight face is not automatically a balanced face.

In this patient, the brows were preserved, the eyelids were redraped, the lower eyelid-cheek junction was structurally supported, the cheeks were elevated, the folds were softened, the jowls were improved, and the neck was refined.

Each area was treated as part of a connected anatomical system. That coordination is one reason the result appears restored rather than simply pulled.

Who May Be a Candidate for a Midface Lift?

A patient may be considered for a midface lift when cheek descent contributes to under-eye hollowing, deeper folds, lower-face heaviness, or an aged appearance that cannot be addressed adequately with skin treatments or filler alone.

Potential candidates may have:

• Meaningful descent or mobility of the cheek tissues
• A hollow or poorly supported lower eyelid-cheek junction
• Nasolabial folds worsened by cheek descent
• Jowls or lower-face heaviness connected to midface aging
• Good overall health
• Realistic expectations regarding surgery and recovery
• A desire for structural correction rather than temporary volume replacement alone

Not every patient with under-eye hollowing or nasolabial folds needs surgery. Some patients may be better treated with eyelid surgery, fat transfer, filler, skin resurfacing, or a more limited procedure.

The appropriate plan depends on facial anatomy, skin quality, tissue laxity, previous procedures, health history, and the patient’s goals. An in-person examination is necessary to determine whether a midface lift is appropriate.

Recovery and Surgical Considerations

Recovery after a midface lift or comprehensive facelift varies according to the extent of surgery, the procedures combined, and the individual patient’s healing response.

Patients may experience swelling, bruising, tightness, numbness, temporary asymmetry, and changes in facial sensation during the early recovery period. These changes generally improve as the tissues settle, but residual swelling and scar maturation may continue for several months.

Potential surgical risks may include:

• Bleeding or hematoma
• Infection
• Delayed wound healing
• Visible or widened scars
• Temporary or persistent numbness
• Facial nerve injury
• Asymmetry
• Lower-eyelid malposition
• Implant-related complications
• Hairline changes
• Anesthesia-related risks
• Need for revision surgery

This list is not exhaustive. Risks, recovery expectations, and postoperative instructions should be reviewed during a consultation with a qualified plastic surgeon.

Frequently Asked Questions

What is a true midface lift?

A true midface lift elevates and supports the cheeks, lower eyelid-cheek junction, and central face. The goal is to restore cheek position and stability rather than simply tighten the skin.

Why do some facelifts not fully correct the cheeks?

Some facelift techniques focus primarily on the lower face, jowls, jawline, and neck. The midface contains different anatomical planes and support structures, so cheek descent may require additional or differently directed elevation.

What is cheek laxity?

Cheek laxity is looseness, mobility, or descent of the cheek tissues. It occurs when the cheek fat pad and supporting structures move downward over time.

Can a midface lift improve nasolabial folds?

Yes. A midface lift may soften nasolabial folds when cheek descent contributes to their depth. It may not eliminate the folds completely, and results depend on anatomy, skin quality, volume loss, and tissue laxity.

Can fillers fix nasolabial folds?

Fillers may soften mild folds, but they do not reposition descended cheek tissue. If the fold is caused largely by laxity and descent, lifting the cheek may provide a more structural improvement.

What are tear trough implants?

Tear trough implants are implants used to provide structural support beneath the eyes and improve hollowing in the lower eyelid-cheek junction.

Does a Ponytail Facelift leave scars?

All surgical procedures create scars. The Ponytail Facelift is designed to place incisions in carefully selected locations to reduce their visibility and avoid an obviously operated appearance. Scar quality and visibility vary among patients.

What does “surgical stigma” mean?

Surgical stigma refers to visible signs that a person may have undergone surgery, such as conspicuous scars, distortion, excessive tightness, hairline changes, or an unnatural facial appearance.

Can a facelift improve the neck?

Yes. A customized facelift plan may include neck refinement, jawline definition, platysmal band correction, treatment of loose neck skin, and other procedures based on the patient’s anatomy.

How long does it take to see final facelift results?

Many patients see substantial improvement within the first few months, but the result may continue to refine as swelling resolves, scars mature, and the tissues settle.

The Bottom Line

This case demonstrates what Dr. Kao means by a true midface lift. The cheeks were elevated, supported, and more stable. The nasolabial folds appeared softer. The lower eyelid-cheek junction was improved. The jawline became more defined, and the neck appeared more refined.

This is not facial rejuvenation based solely on pulling or cutting skin. It is an approach centered on anatomical restoration.

For Dr. Kao, a successful result is one in which the face appears refreshed, balanced, and naturally harmonious without conspicuous scars, distortion, excessive tightness, or an obvious surgical appearance.

Dr. Chia Chi Kao

Dr. Chia Chi Kao is a board-certified plastic surgeon in Los Angeles and Santa Monica and the creator of the groundbreaking Ponytail Lift®. Known for his artistic approach and advanced endoscopic techniques, Dr. Kao specializes in facial rejuvenation procedures designed to deliver natural, long-lasting results.

With decades of surgical experience and a reputation for innovation, he has been featured in leading publications such as The Wall Street Journal, The New York Times, and Glamour, where his techniques and aesthetic philosophy have been widely recognized.

Dr. Kao is the founder of Kao Plastic Surgery, where he continues to advance the field of aesthetic medicine through precision, innovation, and patient-centered care.