11/11/2025
For years, she struggled with hollow under eyes, flat cheeks and a bottom heavy face shape, concerns that she tried to address with injectable fillers which seemed to help temporarily, but over time she noticed what so many patients do: her face looked unnaturally puffy and the filler moved to other areas. Since filler is a liquid that often shifts under facial muscle contraction filler migration not only caused the initial improvement to disappear but also weighed down her midface and created unevenness and a bottom heaviness that she tried to offset with more filler, creating a vicious cycle. She said that she reached the point where she didn’t recognize herself.
In consulting with her, she wanted both a permanent solution to the hollowness but also a more lifted eye shape and brows to frame her eyes most beautifully from above. The ideal approach for her was a combination endoscopic brow and midface lift with bone structural midface implants made of high density porous polyethylene. Through small hidden incisions in her scalp and inner lower eyelids, I created a tunnel extending from the temples to her midface and along the inferior orbital rim, where I placed the implants. This gave her naturally enhanced contour of her midface without the puffiness, and significantly improved support for overlying soft tissues.
To refine the transition from eyelid to cheek, lower blepharoplasty with orbital fat transposition and microfat grafting helped create a soft, natural blend between the midface and eyelid. The result is not only natural but also much more cost-effective in the long term because she’ll never need filler again.
Because the midface and lower eyelid are now properly supported, she’ll also enjoy a more favorable arc of aging — meaning her tissues will maintain lift and contour over time rather than sagging prematurely as is common in patients with negative vector. It’s like a house built on a strong framework is destined to last.
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