Dr. Esin Özlem Atmış
Endoscopic Midface and Cheek Lift
Lifting the cheeks and the area under the eyes through small incisions in the hairline, planned together with the lower eyelids and the brows.
Facial surgery · Cheeks and lower eyelid–cheek junction
Lifting the cheek where it started to descend.
The midface is the area between the lower eyelids and the corners of the mouth. When the cheek fat and its support descend, the lower eyelid looks longer, a groove appears between eyelid and cheek, and the cheek looks flatter. An endoscopic midface lift repositions these tissues upwards using a small camera, without the incisions in front of the ear that a facelift needs.1,2
This page explains who it suits, how it differs from a facelift or fillers, how to prepare, what recovery involves and how to plan a stay in Istanbul.
In short
- Lifts the cheek and the eyelid–cheek junction; adds cheek projection and fullness under the lower eyelid.1
- Less effective for a deep fold between the nose and mouth, and it does not treat jowls or the neck.1,3
- Small incisions in the hairline; often combined with a brow lift or eyelid surgery.2
- Usually one night in hospital; plan about a week in Istanbul, until stitches or staples are removed.2
- Medicines that affect bleeding, supplements and smoking are reviewed weeks before surgery.4,5
Who a midface lift can help
A midface lift is considered when the main change is in the cheeks and under the eyes rather than at the jaw:
- the cheek has moved down and looks flatter from the side;
- a visible groove or a long-looking lower eyelid separates the eye from the cheek;
- the lower eyelid has been pulled down after earlier eyelid surgery, partly because the cheek has descended.1
In a published series of 39 endoscopic midface lifts, the operation increased cheek projection and lower eyelid fullness, and it was also used to support retracted lower eyelids. It was less effective at softening a deep nasolabial fold.1
Midface lift or facelift? If the jowls and neck have also changed, a deep plane facelift addresses the cheek, jawline and neck in one plan. A midface lift is more focused and suits earlier, mainly central changes.
Comparing the options
| Option | What it changes | Limits |
|---|---|---|
| Endoscopic midface lift | Repositions the cheek and supports the lower eyelid1 | Little effect on jowls, neck or a deep nasolabial fold1 |
| Deep plane facelift | Cheek, jowls and jawline; the neck when combined3 | Longer incisions around the ear and a longer recovery6 |
| Lower eyelid surgery | Bags and excess skin of the lower eyelid7 | Does not lift a descended cheek |
| Fillers | Add volume | Do not move descended tissue back; repeated large volumes can make the face look heavy |
The cheek, the lower eyelid and the brow influence each other, so they are assessed together. Many patients considering a midface lift also ask about eyelid surgery or a brow lift.
The consultation and examination
01 · Listen
Which change bothers you most, and how you looked five or ten years ago.
02 · Examine
Cheek position, bone support, lower eyelid tone and position, previous fillers and earlier eyelid surgery.
03 · Check the eyes
Dry eye and incomplete eyelid closure need attention before any lift around the eyes.2
04 · Decide together
Midface lift alone, combined with the eyelids or brows, a facelift, or no surgery.
Before surgery: blood thinners, supplements and smoking
Bring a written list of every medicine, injection and supplement you take, including doses. The table shows what usually happens; it is not an instruction to stop anything yourself. Blood thinners protect against stroke and clots, so any pause is agreed with the doctor who prescribed them.4
| Medicine | What usually happens before planned surgery |
|---|---|
| Warfarin | Usually stopped about five days before surgery; some patients need a temporary heparin injection plan.4 |
| Apixaban, rivaroxaban, edoxaban, dabigatran | Usually paused one to two days before, depending on bleeding risk; dabigatran needs longer when kidney function is reduced.4 |
| Clopidogrel, ticagrelor, prasugrel | If the cardiologist agrees, usually stopped about 5, 3 to 5, and 7 to 10 days before respectively. After a recent coronary stent, planned surgery is often postponed.4 |
| Aspirin | Often continued when it is taken to protect the heart; the decision is individual and made with your prescribing doctor.4 |
| Ibuprofen, naproxen and similar painkillers | Increase bleeding and are usually avoided before surgery; paracetamol is the usual alternative.7 |
| Vitamin E, ginkgo, garlic, ginseng and other supplements | Can increase bleeding; usually stopped at least two weeks before, sometimes three.8,6 |
| Weight-loss or diabetes injections (GLP-1 medicines such as semaglutide or tirzepatide) | Most people can continue them, but the anaesthesia team must know. Surgery may be postponed during dose increases or if you have nausea or vomiting; some patients need a liquid diet for 24 hours before.9 |
Bleeding disorders. Tell us at the first contact if you have a diagnosed bleeding disorder (for example von Willebrand disease or haemophilia), a low platelet count, liver disease, or a history of unusual bleeding after tooth extractions, operations or with periods. Blood tests and a haematology opinion come before any surgical plan. Some people are better served by not having elective cosmetic surgery at all.
Blood pressure and diabetes. Poorly controlled blood pressure or diabetes increases the risk of a collection of blood under the skin (haematoma) and of poor healing; both should be well controlled before surgery.6
Smoking and nicotine. Stop all nicotine, including vapes, patches, gum and snus, at least three to six weeks before surgery and for three to six weeks afterwards. Nicotine narrows small blood vessels and raises the risk of wound problems and skin loss; if you relapse, tell us, because postponing is safer.5
The operation
The operation is done under general anaesthesia. Through small incisions in the temple hairline the surgeon uses an endoscope (a thin camera) to release the cheek tissues from the bone and to lift and fix them in a higher position.1,2 Depending on the anatomy, additional access through the lower eyelid or inside the mouth may be used, and the brow or eyelids can be treated at the same time.
Recovery and risks
| Time | What is typical |
|---|---|
| First 1–2 days | Tension-headache-like discomfort; cold packs around the eyes for the first 24 hours2 |
| Day 1 | Head dressing removed; showering usually allowed2 |
| About 1 week | Stitches or staples removed; sleep with the head raised during this week2 |
| 2 weeks | Avoid vigorous activity; cheek swelling continues to settle2 |
| 1 month | Hair colouring allowed; small fixation devices can be felt under the scalp for some months2 |
Risks include temporary numbness or altered sensation of the scalp, asymmetry, hair loss along the incisions, temporary weakness of the nerve that raises the brow (permanent weakness is much rarer), bleeding, infection, changes in lower eyelid position and the need for revision.2,1
Travelling to Istanbul for a midface lift
Many patients travel from other cities or countries. A clear plan makes the trip calmer and safer:
- Online consultation first: most international patients start with an online consultation. Send your concern, your medical history, your medicines and a few clear photos through the channel the practice arranges, before you book flights.
- Arrive at least one day before surgery: the anaesthesia assessment and the final examination take place before the day of the operation.
- Hospital stay: usually one night; a second night is optional.
- Time in Istanbul: plan about a week, until stitches or staples are removed and the wounds are checked.2 The exact number of days is confirmed after the consultation.
- Follow-up: reviews are planned at 1 month, 3 months, 6 months and 1 year. They can be done online if you live abroad; you will know whom to contact for urgent questions after you return home.
Dr. Atmış and the midface
Op. Dr. Esin Özlem Atmış is an ENT and facial surgeon in Istanbul. She completed her specialist training in otorhinolaryngology at Ankara University Faculty of Medicine in 2014 and is a member of the Turkish Facial Plastic Surgery Association. She is one of the congress presidents of Face Bosphorus 3 (Istanbul, April 2026), a meeting on facial anatomy and medical practice. At Face Bosphorus 2025 she gave an opening talk and chaired sessions on the upper face and periorbital region, biostimulators and whole-face assessment; she was a listed speaker at Face Minima 2025, and at the 4th Congress of European ORL-HNS in Barcelona (2017) she chaired sessions that included facial anatomy. Details are on her scientific activities page.
Her congress work on the periorbital region and whole-face assessment is directly relevant here: the cheek, the lower eyelid and the brow are examined together, because lifting one changes how the others look.
Her approach starts with understanding the concern before discussing an operation: what has changed, how it affects you, and which structures are actually responsible. The aim is a proportionate plan that keeps your expression and character, which sometimes means a smaller procedure, a different order of treatment, or no surgery. Besides Turkish, she speaks English and Italian.
Frequently asked questions
Is a midface lift the same as a facelift?
No. It works on the cheeks and the area under the eyes through small hairline incisions; a facelift also treats the jowls and, with a neck lift, the neck.1,6
Will it remove the bags under my eyes?
Not by itself. It supports the lower eyelid and the lid–cheek junction; bags of fat are treated with lower eyelid surgery, which can be combined.1,7
Will the scars show?
They are small and inside the hairline. Hair loss along an incision is possible; careful incision placement helps to avoid it.2
Can fillers do the same thing?
Fillers add volume but do not move descended tissue back; in some faces a combination is planned.
When can I return to work?
Many people return to desk work after about two weeks, when vigorous activity is still avoided and swelling has mostly settled.2
Will I have headaches afterwards?
Tension-headache-like discomfort is common in the first one or two days and is treated with regular pain relief.2
Clinical references
- Sullivan SA, Dailey RA, Hester TR, McCord CD. Endoscopic subperiosteal midface lift: surgical technique with indications and outcomes. Ophthalmic Plast Reconstr Surg. 2002;18(5):319-330.
- Raggio BS, Winters R. Endoscopic Brow Lift. StatPearls, NCBI Bookshelf (updated 2025).
- Hohman MH, Raggio BS, Patel BC. Deep Plane Facelift. StatPearls, NCBI Bookshelf (updated 2026).
- Perioperative management of antithrombotic medications: guidelines from the American College of Chest Physicians (summary in Am Fam Physician, 2023).
- American Society of Plastic Surgeons. How nicotine sabotages plastic surgery.
- Mayo Clinic. Face-lift.
- Mayo Clinic. Blepharoplasty.
- American Society of Anesthesiologists. Herbal and dietary supplements and anesthesia (patient leaflet).
- American Society of Anesthesiologists. Multi-society guidance on GLP-1 receptor agonists before elective surgery (2024).
This page is general information, not a personal diagnosis or treatment recommendation. Medicines must never be stopped without the advice of the doctor who prescribed them. Seek urgent medical care for heavy bleeding, rapidly increasing swelling, breathing difficulty, chest pain or sudden vision changes after surgery.
Start with a careful, honest consultation.
A consultation is not a commitment to surgery. It is where your concern, your anatomy and your health are looked at together.