Noah E. Meltzer

The midface is bounded by the glabella superiorly and the subnasale inferiorly. Aesthetic subunits in the midface are the lower eyes, cheeks, and nose. Midface abnormalities can dramatically impair appearance, they can produce pooling of tears (in ectropion), or be a sign of systemic illness such as human immunodeficiency virus (HIV).

Rhytids and aging changes can be seen in the midface.

Prominence of the nasolabial (also called melolabial) folds: Due to descent of the malar fat pad inferomedially. This descent produces a deepened nasolabial crease with a more prominent nasolabial fold.

Sun exposure

Malar ptosis is the inferomedial displacement of the malar fat pad. Causes include the following:

Aging

Trauma and failure to resuspend the malar periosteum may result in unilateral malar ptosis.

Malar hypoplasia produces a short and retruded midface, often with bite malocclusion. This can occur in isolation or be associated with a congenital craniofacial syndrome.

Submalar wasting is the progressive atrophy of the submalar fat pads. This is often seen in conjunction with progressive fat atrophy throughout the face and body. Causes include the following:

Aging

Facial wasting syndrome can be due to highly active antiretroviral therapy (HAART) for HIV; this can also include insulin resistance, central adiposity, and hyperlipidemia.

HIV-associated lipodystrophy is the atrophy of fat in the face, as well as the rest of the body, seen in untreated patients with HIV.