Can a Deep Plane Facelift Fix Nasolabial Folds and a Sunken Midface?

6 hours ago

5 min read

Quick answer: Yes, a deep plane facelift can soften nasolabial folds and improve a flat midface, because it lifts the cheek fat pad that slides down and hangs over the fold with age. A skin-only lift or SMAS plication usually has less effect here. The fold itself is a natural crease, so it will not disappear completely, and deep folds often benefit from fat grafting or skin treatment added to the lift.

Key takeaways

Nasolabial folds deepen mainly because the cheek fat descends, not only because skin loosens.
Releasing the zygomatic ligaments allows the cheek to move back onto the cheekbone.
Fillers in the fold can make the face heavier if the cheek is still descending.
Fat grafting can restore lost volume and improve skin quality around the fold.
A natural crease remains; the goal is softening, not erasing.

Why nasolabial folds deepen

In youth, the cheek fat sits high on the cheekbone. With age, the ligaments that hold it loosen and the fat slides down and forward. It then rests on top of the nasolabial crease, which makes the fold look deep and the cheek above it look flat. Bone and fat volume loss in the midface add to this effect.

What a deep plane midface lift does

In a deep plane facelift, the surgeon releases the zygomatic ligaments under the cheek. The cheek fat pad and SMAS can then be lifted up and back as one unit. When the cheek returns to its earlier position, the weight on the fold decreases and the fold softens. At the same time the lower eyelid-cheek junction can become smoother.

Video: Scarless facelift in a young patient: endoscopic midface lift before and immediately after. Watch on YouTube

The video above, viewed more than 4.6 million times, shows a young patient before and immediately after a midface lift performed endoscopically by Prof. Dr. Suleyman Tas, with very little swelling right after surgery.

Scarless facelift before and after
Scarless facelift before and after
Scarless facelift before and after

Facelift or fillers for nasolabial folds?

Fillers placed directly in the fold can help a young face with mild volume loss. When the cheek has already descended, adding filler to the fold may add weight to the lower face and make it look fuller rather than younger. Many patients who come for a facelift have had years of fillers in this area. See facelift vs fillers.

When fat grafting is added

Volume: your own fat, taken from the abdomen or thighs, restores the cheek and fills the depth of the fold.
Skin quality: nano fat, a finely processed form of fat, is used under thin skin to improve texture.
Lasting effect: a part of the grafted fat does not survive, so a small touch-up is sometimes needed.

Read about combinations in facelift combined with eyelid surgery, brow lift or fat transfer.

"The fold is a signpost. It tells me the cheek has moved. If I fill the signpost instead of moving the cheek back, the face becomes heavier, not younger." — Prof. Dr. Suleyman Tas

Video: Mid-facelift, rhinoplasty and fox eyes before and after: seven combined procedures. Watch on YouTube

The second video shows a woman before and 7 days after a combined procedure including a mid-facelift, rhinoplasty and fox eye lift.

Endoscopic midface lift vs deep plane facelift

Endoscopic midface lift: done through small incisions in the hairline and sometimes inside the mouth; suits younger patients with early midface descent and little jowling. See the endoscopic facelift guide.
Deep plane facelift: lifts the midface together with the jowls and neck; suits patients with sagging in the lower face as well.

Recovery

Swelling in the cheeks is common in the first 1 to 2 weeks. Smiling may feel stiff for a few weeks. Most patients return to social life after 2 to 3 weeks, and the fold area keeps softening for 3 to 6 months.

What a facelift cannot do for the fold

A facelift does not remove the natural crease between the cheek and the lip, which is present even in young faces. Fine lines on the skin surface need laser or peel treatment. Very thin skin may show the fold sooner as the years pass.

Who is a good candidate?

You may benefit from a deep plane midface lift if the cheek looks flatter than before, if the fold beside the nose has deepened over the years, if fillers in the fold no longer help or make the face look heavier, and if the jowls have started to form. Good candidates are healthy non-smokers who want to look rested rather than different.

What to expect in the first weeks

Week 1: cheeks feel full and tight; smiling is limited.
Week 2: most bruising has faded; the fold already looks softer.
Weeks 3 to 6: expressions become natural again.
Months 3 to 6: the midface settles into its final contour.

Risks specific to the midface

Swelling of the lower eyelids, temporary changes in smile symmetry and numbness of the cheek are possible and usually settle within weeks to months. Fat grafting can leave small irregularities that sometimes need a touch-up. Read deep plane facelift risks and complications.

Frequently Asked Questions

Does a deep plane facelift get rid of nasolabial folds?

It softens them by lifting the cheek fat that hangs over the fold. A natural crease remains.

Is fat grafting better than filler for the folds?

Fat is your own tissue and also improves skin quality. Filler is quicker and reversible. When the cheek has descended, lifting it is usually more effective than either alone.

Can a mini facelift fix nasolabial folds?

Usually not much. A mini facelift mainly lifts the jowls; its effect on the midface is limited.

How long do the results last?

The lift lasts for years, although ageing continues. Grafted fat that survives behaves like normal fat.

Will my smile change?

Smiling can feel tight for a few weeks; the natural expression returns as swelling settles.

About the Author

This article was written and medically reviewed by Prof. Dr. Suleyman Tas, a plastic, reconstructive and aesthetic surgeon in Istanbul with over 20 years of experience. He is the author of Rhinoplasty in Practice (CRC Press, 2020), has more than 40 peer-reviewed scientific publications and five patents, and teaches facelift and rhinoplasty techniques to surgeons at international courses. Read more about Prof. Dr. Suleyman Tas.

Individual results vary. Before and after photos and videos are shared with patient consent. This article is for general information and does not replace a personal medical consultation.

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