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Balanced Restoration: Optimizing Midface Rejuvenation Using Hyaluronic Acid Fillers.

Rod J Rohrich¹, Raul Cetto², Conor J Gallagher³

¹From the Dallas Plastic Surgery Institute, Dallas, TX.

Plastic and Reconstructive Surgery. Global Open

|February 26, 2026

Summary

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Balanced restoration using multilayered hyaluronic acid fillers is a modern approach to midface rejuvenation. This technique considers distinct superficial and deep fat layers for natural-looking results that preserve facial expression.

Area of Science:

Aesthetic Medicine
Dermatology
Facial Anatomy

Background:

Current hyaluronic acid (HA) fillers for midface aging focus on deep fat compartments.
Evolving filler technology necessitates a revised approach to midface volume restoration.

Purpose of the Study:

To propose balanced restoration, a multilayered technique, as the contemporary standard for midface revolumization with HA fillers.
To achieve natural-looking outcomes that maintain dynamic facial expression through an advanced anatomical understanding.

Main Methods:

Differentiating between superficial and deep midface fat compartments based on anatomical and functional attributes.
Selecting appropriate HA filler products with specific viscoelastic properties tailored to each fat layer.
Implementing multilayered techniques for balanced restoration.

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Main Results:

The midface has distinct superficial and deep fat layers with different properties and functions.
Superficial fat compartments require fillers with cohesive and dynamic properties for natural movement and expression.
Deep fat compartments require fillers suited to their more static nature.

Conclusions:

Balanced restoration, a multilayered approach, represents an advanced strategy for midface rejuvenation.
Tailoring HA filler selection to superficial and deep fat layers ensures optimal aesthetic outcomes.
This technique enhances facial contours while preserving natural facial dynamics and expression.