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The Tangled Web of Midface Rejuvenation city, state

The midface, in aesthetic and anatomic terms, is the part of the face from the lower eyelids to the upper lip. At first glance, it may not seem that there is a lot going on here. However, more careful analysis shows that aging in the midface is complicated and multifactorial. In addition, changes here play an extremely important part in the overall aesthetic changes of the aging face. The subtle but complex anatomical and functional issues of the midface have inspired a similarly complex web of surgical, non-surgical, and minimally-invasive treatments. This includes everything from the nearly ubiquitous Botox® Cosmetic and soft-tissue fillers, to less commonly performed operations like the endoscopic midface lift.

As you can imagine, evaluating the results of the myriad midface rejuvenation treatments is extremely difficult for patients. In fact, it has also been difficult for plastic surgeons! As an attempt to bring some clarity, at least for the surgical and minimally-invasive approaches, Dr. Andrew Jacono and I have published an article in JAMA Facial Plastic Surgery ( In this study, we present a comprehensive evaluation of different surgical techniques, including extended lower lid blepharoplasty, facial fat grafting, endoscopic midface lift, and deep plane facelift, alone and in combination. Perhaps most importantly, we chose as our outcome measure the only outcome that really matters in aesthetic surgery – patient satisfaction with the results.

Extensive analysis of data from 150 patients who underwent midface rejuvenation procedures revealed a few important points. First, about one third of patients required a combined approach owing to the complex nature of the aging midface. Second, facial fat grafting alone had the highest rate of dissatisfaction among patients, while extended lower blepharoplasty (lower eyelid lift) with orbital fat preservation and transposition had the highest rate of satisfaction. And finally, in patients with certain anatomic issues (such as a relatively flat cheekbone area), a combination of lifting and volumizing techniques (either with fat or with implants) is the key to success.

For more information about midface rejuvenation, including non-surgical options, or to learn more about my approach to the lower eyelid-cheek complex, please visit or call 415-550-1077 today for a comprehensive consultation!

Evan R. Ransom M.D.
Facelift Specialist in San Francisco
San Francisco Center for Facial Plastic, Reconstructive & Laser Surgery

Our Patient Reviews

San Francisco Center for Facial Plastic, Reconstructive & Laser Surgery

5 / 5.0

Based on 23 reviews

Christina G.

I had several nasal/sinus issues including a severely deviated septum and a dorsal hump, which I wasn't crazy about. Dr Ransom did both the medical and aesthetic parts of my surgery and he did a wonderful job! While I did have some swelling, I didn't experience much bruising at all. I loved that he left the natural look of my nose just making small corrections. My breathing has GREATLY improved. His office staff was super helpful in scheduling and making sure payment and everything was very clear. I am very, very, very pleased with my results!!

Tk I.

I had a terrible surf accident in Bali and needed to get 50 stitches to repair what the reef did to my face. I had emergency cosmetic surgery in Bali the day of the accident. Immediately when i got back to the states i was introduced to Dr Ransom through some mutual friends. I was searching for the best cosmetic surgeon in San Francisco to help in my recovery. He and his team have been amazing! he helped establish a plan for my post-op wound care/treatment and administered some initial laser treatments. Dr Ransom and his team are extremely knowledgeable and very patient / helpful. I am very grateful for their help and support. I am finally looking normal again!

Joey B.

I had three issues with my nose - which inhibited my breathing: 1- broken nose, 2 - narrow nostrils that collapsed when I inhaled through my nose, 3 - deviated septum. When I was living in New York, I went to see a doctor about my breathing issues, and he said my skin was too thin and there was likely nothing he could do to rectify the problem. Dr. Ransom was recommended by an ENT I saw through One Medical. As soon as he saw him, he said he could easily fix my nose, and remove the bump that had formed from the trauma. His confidence and strong sense of self immediately put me at ease, and I had little doubt that he could accomplish exactly what he promised. He showed me a modified picture of my nose , and really liked what he proposed. The end result very closely matched what he promised. Not only can I now breath much more easily through my nose, it looks much better. He managed to make it look like an improved version of itself, however I still look like me, and unless I tell anyone I had it done, it's not overly noticeable, which I prefer. I'm pretty vain and very critical, and I can say that Dr. Ransom is great, and comes highly recommended.

Edward T.

Doctor Evan Ransom took my surgery on relatively short order and did a wonderful job. He is very talented and has a nice friendly professional support staff. I can not thank him enough, he was calm, caring, professional and interested in the follow results of his work . He seemed to bring a certain artistry to the profession.

Lisa C.

Dr. Ransom is a talented physician. He is knowledgeable, professional and goes the extra mile to make you feel comfortable during your treatments. He has been blessed with an artistic eye which brings wonderful results. I highly recommend Dr. Ransom and would refer all of my friends and family members to choose him as their physician.

Cheryl H.

Dr Ransom is very kind, honest, and conscience doctor. I was referred by my best friend, she is also Doctor Ransom patient. She has so much good things said about Doctor Ransom. So I had a face lift done by Doctor Ransom on July 2015. He did a wonderful job on my face and I have a lot of compliments on my face. So if anyone want to get their face done. I would highly recommended Doctor Ransom to you. I give Doctor Ransom a five stars.

Jill P.

I have currently been getting botox regularly with Dr. Ransom and he does a fantastic job. My previous doctor's office moved to another location where it was no longer convenient. I didn't realize what I was missing until I went to Dr. Ransom. I felt really comfortable, but most important he did a terrific job blowing my previous doctor out of the park. (Sometimes it's good switch it up a bit to make sure you are getting the best treatment.) On top of that, Dee the office manager is an incredible asset to the office. She personalizes your visit and relationship with the office to an extent I have never experienced before. I even get follow up calls to see how I am doing after a treatment. I highly recommend Dr. Ransom for his great work, and his team's impeccable customer service.

Arielle C.

Dr. Ransom and Dee are the BEST! Whether it's aesthetic or reconstructive, I'd trust him over and over again with my face.