Midface Lifting for Under-Eye Hollows, Deep Nasolabial Folds, and Lower Face Sagging

Hello! This is Dr. Hanjeong Lee, board-certified plastic surgeon and chief director of ATOP Plastic Surgery—your go-to expert for anti-aging and lifting procedures.

As we age, it’s completely natural for our faces to gradually sag and develop wrinkles. But when those changes happen too quickly or become too noticeable, even looking in the mirror can start to feel discouraging.

Today, I’d like to share the real story of a woman in her 50s who came to us with those very concerns, and how we helped her restore a more youthful appearance.

She was particularly worried about her deep nasolabial folds and severe sagging in the lower face, especially below the cheeks (mid-to-lower face area). These changes made her face appear wider and more square-shaped than before.

🔍 1. Understanding the Patient’s Concerns in the Initial Consultation

During the first consultation, the patient appeared quite down and discouraged.

1. Her under-eye area was bulging, making her look significantly older.

2. The deep nasolabial folds gave her a harsh, stern appearance.

3. Sagging in the mid-cheek and jowl areas caused her face to appear square-shaped, and the hollowed-out sides of her cheeks made her face resemble a peanut shape.

   
   

What she truly wanted wasn’t just to erase wrinkles—it was to achieve a natural and refreshed look. Rather than hearing, “Oh, she had surgery,” she hoped people would say, “Wow, she looks so much younger—how did she do it?”

During the consultation for midface lifting, I explained that achieving a natural and refreshed look isn't just about tightening sagging skin — it requires gently reshaping the overall facial contour for a smoother and more harmonious appearance.

1. First, we needed to soften and fill the deep hollows under the eyes.

2. To address the nasolabial folds, we planned to reposition the fat layer in the front cheek area to its original location using SMAS lifting techniques.

3. Similarly, the fat along the sides of the cheeks (jowls) would be lifted back to its proper position to naturally restore volume to the hollowed areas.

4. Any remaining uneven volume would be either filled or removed, depending on the area, to reshape the face overall in a balanced and refined way.

📷 2. Preoperative Photo Assessment

The most noticeable concerns were the deep tear troughs and pronounced nasolabial folds, which made her look significantly older than her actual age. In addition, the lower face (especially the area below the cheeks and along the jawline) showed considerable sagging.

The skin had clearly lost elasticity, giving the impression that the facial contour had collapsed as the tissue drooped downward.

Furthermore, the sagging cheek fat caused her lower face to appear longer and sunken along the sides, contributing to an overall tired and heavy appearance. As the face continued to sag, smiling actually made the wrinkles appear deeper—creating a vicious cycle that made her look even more fatigued and aged when expressing emotion.

Since this level of facial aging cannot be addressed with basic skincare or non-surgical treatments, a surgical approach targeting the deeper tissue layer (SMAS) was necessary.

Our recommended surgical plan included:

1. Lower blepharoplasty to correct under-eye bulging and hollowness

2. A deep plane facelift, which lifts not only the skin but also the underlying SMAS (muscle) layer, providing longer-lasting and more natural results

   
   

To minimize scarring, we combined this with our signature Fox line lifting (for mid-face sagging) and jowl lifting techniques.

3. Since lifting alone wasn’t enough to resolve all facial volume issues, we also performed liposuction on the jowl and double chin areas

4. The harvested fat was then purified and grafted into the nasolabial folds, front cheeks, and perioral wrinkles to restore volume where it was lacking

✨ 3. Surgical Procedure Overview

Before performing the midface lift, we began with liposuction to remove any unnecessary fat. The lifting procedure was carried out through minimal incisions hidden within the hairline around the ears, making the scars virtually invisible.

Next, we carefully lifted and secured the SMAS layer (the fascia located just beneath the skin). Excess skin was then trimmed little by little to refine the facial contours in a natural and balanced way.

One of the most critical aspects of this process was to avoid over-tightening.

We meticulously adjusted the tension to ensure that the patient's facial expressions remained natural, achieving a rejuvenated look without any stiffness.

💖 4. The Changes After Surgery

Pre-op – 3 Months Post-op

Pre-op – 3 Months Post-op

Post-surgery, the tear troughs under the eyes have nearly disappeared, and the skin in that area appears tighter and smoother.

The deep nasolabial folds, which were a major concern, improved significantly as the fat in the front cheek area was repositioned to its original place, creating a natural contour and reducing the sagging effect.

The jowl area showed the most SMAS layer movement inward, and with the fat layer properly lifted, the previously collapsed facial contours were restored, resulting in a slimmer, more youthful cheek profile.

Overall, the face looks more vibrant and bright—giving the patient an appearance at least 10 years younger than her actual age.

🎈 In Conclusion…

Midface lifting surgery is not just about looking younger — it’s a precious journey to regain lost confidence and happiness.

Because returning quickly to your daily life is just as important, we focus on minimizing incisions and swelling to ensure a smooth recovery.

If you’re facing similar concerns, don’t hesitate — take that brave first step forward.

No matter what worries you have, we are here to find solutions together and help you become beautiful again.

Thank you very much!