Midface: A Comprehensive Review of Surgical Techniques for Youth Restoration Over the Past Decade

Abstract

The aim of the present article is to conduct a comprehensive literature review that identifies the most commonly used surgical techniques in midface rejuvenation, compares their indications, ease of execution, complication rates, and long-term stability. A scoping review on midface lift surgical procedures was conducted following the PRISMA Extension for Scoping Reviews (PRISMA-Scr) guidelines. To address the research questions, three reviewers with varying levels of expertise in facial plastic surgery were selected. A search string was developed following the PICOS table. Three databases (PubMed, Scopus, and Cochrane) were searched for articles in English published between 2015 and 2025. Subsequently, the Rayyan online platform was used to screen titles and abstracts in a blinded manner, reaching the final pool. From an original set of 460 articles retrieved from the databases, the reviewers reached consensus on 23 articles. The literature conveys that midface lift techniques are primarily indicated to correct tear trough deformity, nasolabial folds, loss of cheek volume, and orbital hollowing. However, for upper, lower, and neck ageing, a more invasive classic facelift is often required. More obvious results are achieved with suborbicular (subSMAS) or subperiosteal approaches that release the midface ligaments, whereas subcutaneous techniques are much less effective. The choice of technique depends on several factors, including the patient's needs, previous surgical history, and the surgeon's experience. Complications are comparable between suborbicular (subSMAS) and subperiosteal techniques, as is invasiveness. Standard additional procedures to harmonize may include upper and lower blepharoplasty and malar projection augmentation. Patient satisfaction is subjective mainly due to the lack of a standardised scale, highlighting the need for further outcome studies and objective assessment of results. The midface plays a central role in overall facial aesthetics, and techniques targeting this area are essential for effective rejuvenation and beautification. The decision to employ a sub-SMAS versus a subperiosteal approach often hinges on the surgeon’s preference. However, the absence of a systematic evaluation method and long-term follow-up data limits our ability to determine the superiority of one technique over the other definitively. However, both techniques are comparable in terms of invasiveness and complication rates. The development of an objective scale to assess midface rejuvenation outcomes would greatly enhance standardization and facilitate future studies.