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2026.07.02
What Is the Difference Between a Mid-Face Lift and the Hamra Method? Treating Dark Circles and Sagging from a Mid-Face Perspective
As a plastic surgeon certified by the Japanese Society of Plastic and Reconstructive Surgery, I have been involved in many cases of trauma, reconstruction, and congenital diseases, and have cultivated precise techniques and a deep understanding of anatomy. He entered the field of cosmetic surgery out of a desire to bring the power of cosmetics to his patients, as a change in one's appearance can also make one's mind more positive. Her specialties include general treatment of the eye area, injections, and sagging skin. I provide treatments that focus on beauty with the medical stance of "sincerely addressing the ideals of the patient.
Hello! “Designing natural beauty through trust.” I am Masataka Fujihashi, a board-certified plastic surgeon recognized by the Japanese Society of Plastic and Reconstructive Surgery.
Dark circles under the eyes and sagging cheeks are common concerns for many people, but in actual clinical practice, it’s not uncommon for patients to be unsure about which treatment to choose. Do they want to treat just the dark circles, or do they want to improve the overall appearance of their face? The appropriate treatment varies significantly depending on this distinction.
In this article, I’ll explain the differences between a mid-face lift and the Hamra technique, as well as how to consider combining the two.
What's the Difference Between a Mid-Face Lift and the Hamra Method? Let's Start by Clarifying Their Different Roles
Although we often refer to them collectively as “eye area concerns,” there isn’t just one cause. First, it’s important to clarify exactly “which areas” each treatment targets.
What Is a Mid-Face Lift? | Cosmetic Surgery to Lift Sagging Skin in the Mid-Face
A mid-face lift is a procedure that lifts the soft tissues of the mid-face, including the cheeks.
As we age, the fat and supporting tissues in the cheeks shift downward, and
- The cheeks sag
- Nasolabial folds become deeper
- Dark circles under the eyes become more pronounced
Changes such as these will occur.
In response to these changes, a mid-face lift involves lifting not only the skin but also the underlying tissues—including fascia and fat—and securing them to the periosteum. In other words, rather than simply “pulling” the skin, this procedure reposition the tissues. As a result, the cheeks are lifted, making it easier to achieve overall facial balance.
▶For Those Who Want to Learn More About Mid-Face Lifts
What Is the Hamra Method? | Eye Area Treatment to Smooth Out Puffs and Hollows Under the Eyes
The Hamra procedure is a surgical technique that simultaneously addresses the “bulges” and “hollows” that cause dark circles under the eyes.
Dark circles under the eyes are,
- ・Protrusion (bulging) of orbital fat
- Indentations caused by ligaments and the skeletal structure
In many cases, this is the result of a combination of factors.
A key feature of the Hamra method is that, rather than simply removing protruding fat, it smooths out unevenness by redistributing the fat to the sunken areas.
In particular, the Hamra technique (a method that approaches the area from the skin side) performed at Bianca Clinic allows for simultaneous correction of skin sagging and excess skin, enabling a comprehensive approach that addresses the overall texture of the eye area. As a result, it is possible to achieve a more three-dimensional and natural-looking result while avoiding the risk of the eyes appearing even more sunken after fat removal.
▶For those who want to learn more about the Hamra Act
Who is a good candidate for a mid-face lift and the Hamra procedure?
A mid-face lift and the Hamra procedure are two different treatments that target different areas and serve different purposes. Therefore, when deciding which one is better, it’s important to determine which is more suitable for your specific condition. Here, we’ll outline the types of cases for which each procedure is best suited.
Cases Where a Mid-Face Lift Is Appropriate
A mid-face lift may be suitable for those who feel their cheeks have sagged or who are concerned about nasolabial folds and volume loss in the mid-face. In particular, if you feel that you “look tired” or “look older”—not just because of shadows around your eyes but as a general impression of your entire face—a mid-face approach can be effective.
Cases Where the Hamra Method Is Appropriate
If dark circles are primarily caused by puffiness or hollows under the eyes, the Hamra procedure is a strong option. If the sagging of the cheeks is mild and improving the appearance can be expected by smoothing out the unevenness around the eyes, the Hamra procedure alone is generally considered an appropriate treatment.
Treating the Eye Area and Cheeks as a Single Unit | The Concept of Treating Dark Circles by Addressing the Mid-Face
At Bianca Clinic, we also offer a "W" approach that combines a mid-face lift with the Hamra technique. This is not merely a combination of procedures performed simultaneously, but rather a treatment plan that views the eye area and cheeks as a single, integrated structure.
The cause of dark circles isn’t always limited to the eye area. In many cases, sagging cheeks cast shadows that accentuate the dark circles, making them appear deeper. By performing a mid-face lift to lift the entire midface and using the Omote-Hamura method to smooth out irregularities around the eyes, it’s possible to smoothly restore a continuous line from the eye area to the cheeks.
Furthermore, since the procedure can be performed through the same incision, it is highly efficient. Lifting the cheeks alters the vertical balance of the face, and because excess skin can be removed at the same time, in some cases this not only improves dark circles but also changes the overall impression—such as the appearance of looking “somewhat tired.”
What You Should Know Before Considering Combination Therapy
While this combination allows for simultaneous correction of the eye area and cheeks, it is not suitable for everyone. Since this is a surgical procedure, it is important to carefully consider the risks and indications before proceeding. Here, we will outline the precautions associated with this combination and the criteria for selecting the appropriate surgical technique.
Risks | Precautions Regarding Swelling, Bruising, Asymmetry, Hallux Valgus, Nerve Damage, and Other Issues
Since a mid-face lift is a surgical procedure, there are several risks involved.
＜代表的なリスク＞
- Swelling and bruising
- Left-right difference
- Effects on the Nervous System
In addition, it is important to be aware of the possibility of regression and ectropion (the “sticking-out” condition).
- Possibility of Reversal… Fixation achieved through tacking (stitching) may loosen over time, potentially leading to some reversal.
- Ectropion (protruding eyelid)… Especially with a superficial approach, there is a risk that the lower eyelid may turn outward if fixation is inadequate.
To minimize these risks, it is important to use appropriate design and techniques based on an understanding of anatomy.
Key Considerations in Choosing a Surgical Procedure | Determining Suitability Rather Than the Degree of Effectiveness
A mid-face lift is a procedure that can produce noticeable results, but it is not suitable for everyone. The key is to determine which anatomical structures are responsible for your current appearance.
- Is the main issue the protrusion of fat?
- Is sagging skin the main concern?
- Is it largely due to skeletal structure?
These factors determine the most appropriate treatment. The key to achieving a natural-looking result is not to choose a procedure based solely on its effectiveness, but to select a treatment that is appropriate for the specific condition.
Dark Circles and Sagging Can Be Corrected with a “Midface” Treatment | Options Include the Midface Lift and the Hamra Method
A mid-face lift and the Hamra procedure are two distinct treatments, each serving a different purpose. In some cases, combining the two allows for a comprehensive approach that addresses not only the eye area but also the cheeks.
While concerns about sagging and jowls may seem simple, they are actually influenced by multiple factors. Therefore, it is important to consider the overall balance of the face rather than focusing on isolated treatments.
In particular,
- For those whose dark circles haven't fully improved despite treatment
- For those concerned about sagging cheeks or looking tired
In some cases, a midface approach may be appropriate.
If you're concerned about under-eye bags or sagging skin, why not start by accurately assessing your current condition? You're welcome to contact us even if you just want to discuss your concerns, so please feel free to reach out if you have any questions.
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