Search

Introduction: The surge in the popularity of midface and temporal lifting procedures can be attributed to evolving social media trends and heightened patient expectations, particularly among younger individuals seeking "beautification" rather than traditional rejuvenation. Scarless techniques, such as transtemporal/transoral approaches, are increasingly preferred. This study aimed to combine the advantages of both superficial and deep dissection planes in midface and temporal lifting procedures. Methods: This retrospective study included 184 patients who underwent surgery using a dual-plane midface and temporal lift technique. Preoperative and postoperative assessments, including P1/P2 ratio calculations, were performed to evaluate volumetric distribution in the midface. Results: The study cohort exhibited a significant improvement in the P1/P2 ratio postoperatively (p < 0.05), indicating successful volume redistribution. Complications, including hypoesthesia, bruising, and infection, were managed effectively. Minor asymmetries were observed, with revisions offered, but declined by the patient. Discussion: This technique offers hidden incisions and reduces the risk of scar-related complications, making it suitable for patients seeking facial enhancement. Addressing the tear trough area and the lateral canthus provides comprehensive facial rejuvenation. The dual-plane approach facilitates both skin mobilization and volume shift, yielding favorable aesthetic outcomes. Conclusions: The dual-plane midface and temporal lift technique presented in this study offers a bi-vectoral approach to midfacial lifting, suitable for both beautification and rejuvenation goals. Despite the potential limitations, including infection risk, this method is an effective option for facial enhancement. Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

The traditional deep plane and "low" cheek superficial musculoaponeurotic system (SMAS) flaps elevated below the zygomatic arch suffer the drawback that they cannot, by design, exert an effect on tissues of the midface and infra-orbital region. Traditional deep plane and low designs target the lower cheek and jowl only and produce no improvement in the upper anterior cheek and "midface" area. Planning the flap "higher," along the zygomatic arch, and extending the dissection medially in an "extended SMAS" fashion to release and mobilize midface tissue, overcomes this problem and allows a combined, simultaneous, single flap lifting of the jawline, cheek, and midface. An improved outcome is obtained in many patients and no separate midface lift procedure is needed. [ABSTRACT FROM AUTHOR]

Lower eyelid retraction occurring as a complication of lower eyelid blepharoplasty may give rise to symptoms of exposure keratitis as well as cosmetic considerations. This retrospective longitudinal study describes our clinical experience with 74 patients with bilateral lower eyelid retraction postblepharoplasty (148 eyes) undergoing a transconjunctival subperiosteal midface lift with the implantation of a hard palate spacer graft over the period 2002 to 2019. All patients had a forced-up traction test result of less than or equal to 2 mm, indicating a significant fibrosis of the middle lamellae. Margin reflex distances (MRD2) were examined at follow-up visits scheduled for 2 weeks, 1 month, and 1, 3, 6, 9, and 12 years. Mean follow-up duration was ± 102 months (range 6 to 144 months). In all patients, MRD2 varied up until 1-year postsurgery and stabilized thereafter. Last follow-up MRD2 values indicated retraction improvements of 1.4, 2.4, and 3.2 mm, respectively, for those with mild: MRD2 6.3 mm [5.5 – 6.6], moderate: 7.0 mm [6.7 – 7.8], and severe retraction: 8.5 mm [7.9 – 9]. This improvement was statistically significant in patients with severe baseline retraction (p = 0.04). This approach proved to be safe and functional, and cosmetic results were excellent and remained stable over time. [ABSTRACT FROM AUTHOR]

The midface has been a difficult zone to manage in rejuvenating surgeries. The major challenge for midface lift is to achieve extensive dissection and elevate the composite tissues en bloc through minimal incisions. In a total of 22 composite midface lift cases, a titanium cable wire was used. The wire was made into an elastic loop that guided three SMAS-suspending sutures out of the subcutaneous plane through a short incision at the temporal region. Then, each suture was fixated to the deep temporal fascia. Postoperative complications and the subjective assessment of the patients were evaluated. Surgeries were successfully commenced in all cases. Midface sagging, eye bags, and nasolabial folds all exhibited considerable improvements. Major complications such as nerve injury and alopecia were not observed. The patients were followed up for an average of 16.9 months. In general, 90% of the patients were satisfied with their outcome. This guided suspension suturing technique effectuates a more convenient and efficient way to conduct multi-points anchorage of the composite malar flap. When properly executed, this technique allows the anchorage sutures to bite into the deeper layer of the SMAS that ensures firm suspensions in midface rejuvenation surgery, [ABSTRACT FROM AUTHOR]

Introduction: A harmonious face is defined in terms of a balanced relationship among all facial tissues. This balance among skin, fat, muscle, and bone is lost with aging as progressive changes occur in their volume, shape, position, and consistency. Aging of the human face generally starts in the third decade of life, mainly in the midface and periorbital areas. Traditional face-lifting surgeries result in minimal improvements in the midface area. Various techniques have been developed using different dissection planes and vectors with different forms of incision, including endoscopic techniques. Methods: We attempted to combine endoscopic subperiosteal dissection techniques with the percutaneous needle technique, especially in young- to middle-aged patients. We aim to share technical details of our preferred suspension and fixation method for an endoscopic midface lift with the aid of a percutaneous needle and to present the outcomes of this particular technique in 75 patients. Results: Significant rejuvenation of the nasojugal groove was achieved, and patient satisfaction was high. All cases exhibited satisfactory, symmetrical, and stable elevation of the midface. None of the patients required a second surgery. Conclusion: Trinity lift allowed for stronger, easier, and faster application of sutures during endoscopic facial surgery without any other mucosal or transcutaneous incisions. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: The anatomy of the eyelid changes with age. Multiple changes were observed in the eyelids and the surrounding structures including the malar region. Aging affects the appearance of eyelids and midface by the formation of tear trough deformity and malar flattening and ptosis. To define the effect of malar fat suspension on the lateral part of the infraorbital wall and orbital fat transposition in tear-trough and malar flattening and ptosis., Methods: A retrospective study was carried out on 15 patients who had surgeries between January 2020 and January 2022. This technique combines orbital fat transposition to the medial side of the infraorbital wall and malar fat suspension to the lateral side of the infraorbital wall. The average follow-up period was 12 months. Values were compared by paired samples student or Wilcoxon signed rank test for quantitative and qualitative data respectively., Results: There was a significant improvement in tear trough deformity, malar ptosis, and midface lift ( P < 0.5). No recurrence was observed on follow-up of 12 months. One patient experienced minor postoperative complications in the form of prolonged ecchymosis for 2 months., Conclusion: The transcutaneous lower blepharoplasty with orbital fat transposition and malar fat suspension to the lateral part of the infraorbital wall can be considered a safe and effective intervention with improved aesthetic outcome. Thus, it is recommended in patients with tear trough deformity and malar ptosis., Competing Interests: The authors declare that they have no competing interests., (© 2024 Iran University of Medical Sciences.)

Objective: To describe the combined technique of midface lift and partial release of orbital fat for facial rejuvenation and evaluate the safety and aesthetic results. Methods: This was a single-center study that included patients who underwent facial rejuvenation from January 2010 to December 2016. The orbital fat was partially removed, and the cheek fat pads were repositioned to exfoliate the myocutaneous flaps of the lower eyelids and midface through a sub-ciliary incision. The cheek soft tissue pads and orbital fat were restored and sutured to the periorbital membranes and orbital margins. Postoperatively, the patients were examined at 6 and 18 months for changes in the shapes of cheeks, eyelid joints, sunken eyepit, and nasolabial sulcus along with procedural complications. Results: A total of 179 (177 women; 2 men) eligible patients with a mean age of 47.17 years underwent the procedure. The shapes of cheeks and eyelid joints of all patients improved, along with shallowing of the sunken eyepit and nasolabial sulcus at 6- and 18-month follow-up. The surgical procedure involved minor trauma without facial scarring, lower eyelid flinch, and dislocation. None of the patients reported complications of nerve injuries, long-term chemosis conjunctiva, periocular swelling, or dislocation of the lower eyelids. Only 2 patients who underwent subsequent pouch surgeries had slight ectropion, which was restored within 4 months of surgery. Conclusion: To conclude, the combined partial orbital fat repositioning and midface lift via sub-ciliary approach is a successful treatment option for facial rejuvenation with no major complications. [ABSTRACT FROM AUTHOR]

Context: Several studies showed, from the clinical point of view, the advantages of the various techniques and surgical approaches to obtain facial rejuvenation. A few studies have highlighted the satisfaction or not of patients who underwent a traditional facelift; however, a long-term follow-up study measuring patient satisfaction with midface-lift surgery has not been published yet. Aims: The aim of this study is to measure individual patient satisfaction with the midface lift, to find out from each patient his/her level of satisfaction 1 and 5 years after the operation and to compare the results to assess the benefits of the surgery. Background: Several studies showed, from a clinical point of view, the advantages of the various techniques and surgical approaches to obtain facial rejuvenation; however, a long-term follow-up study measuring patient satisfaction with midface-lift surgery has not been published yet. Materials and Methods: Between January 2005 and January 2010, 163 patients underwent a midface lift. All patients were asked to complete a standardised survey 1 and 5 years after surgery, in order to measure outcomes among facial aesthetic patients. Statistical Analysis Used: The paired t-test. Results: All patients reported an improvement as a result of the midface lift. Statistically significant differences in judgement criteria were found for malar eminence and nasojugal groove. Almost all of the patients turned out to be completely satisfied with their appearance with the new look. Conclusions: Patients were extremely satisfied with their decision to undergo a midface lift and with the outcomes and quality of life following the procedure.

In this article, the interested reader will learn when and how to apply different techniques on their patients, with the goal of safe, effective, natural looking, and long-lasting midface rejuvenation. [ABSTRACT FROM AUTHOR]

The goal of any reconstructive procedure is a complete return to premorbid form and function. Unfortunately, a return of pretraumatic form is routinely not considered during surgical planning. This leads to uncontrolled contracture of the soft tissue elements and permanent disfigurement. The goal of this article is to review interventions that improve soft tissue healing and long-term outcomes. [ABSTRACT FROM AUTHOR]

Résumé La région palpébro-jugale est une région clé qui inspire tous les commentaires : de l’air fatigué à la bonne mine, en passant par l’aspect reposé, sans oublier bien-sûr le charme, la beauté, la jeunesse. Malgré une palette de techniques médicales et chirurgicales intéressante, le traitement de cette région est parfois difficile et les résultats ne sont pas toujours à la hauteur de nos espérances. La blépharoplastie standardisée de soustraction utilisée de façon abusive pour des indications souvent bien différentes a montré ses limites. La lipostructure a révolutionné la blépharoplastie et est devenue avec ses derniers raffinements une technique de référence. Les liftings centro-faciaux sous-périostés apportent des résultats incomparables au prix d’une agressivité technique certaine. La médecine esthétique propose des solutions alternatives ou complémentaires dignes d’intérêt. Nous avons passé en revue les différentes procédures à notre disposition avec leurs atouts et leurs limites et nous avons tenté de codifier les indications thérapeutiques. Le positionnement du sillon palpébro-jugal clinique par rapport au rebord orbitaire inférieur influence notre stratégie quant au choix des techniques retenues. Summary The eyelid-cheek junction is a key area which generates many comments: from looking tired to looking good or rested, without forgetting charm, beauty, and a youthful appearance. In spite of many interesting medical and surgical procedures, treating this area is sometimes difficult and results are not always up to our expectations. Standardized blepharoplasty, which has often been improperly used, has shown its limits. Since the latest refinements, lipostructure has revolutionised blepharoplasty and serving as a reference, it has become an established technique. Subperiostal mediofacial lift allows outstanding results at the cost of a certain technical aggressiveness. Aesthetic medicine proposes worthy alternative and/or appropriate complementary solutions. Different procedures we dispose of have been reviewed together with their assets and their limits. A codification of therapeutic indications is proposed. The positioning of the eyelid-cheek clinical junction in relation with the low orbital bone rim influences our strategy in choosing the appropriate technique. [ABSTRACT FROM AUTHOR]

This article describes our surgical technique for subperiosteal midface elevation in patients with paralytic lower eyelid malposition or cicatricial inferior eyelid retraction. Nineteen patients with paralytic lower eyelid malposition and 15 patients with cicatricial inferior eyelid retraction underwent a subperiosteal midface lift (n= 34). The procedure was performed under local anesthesia through three nonvisible incisions. A transconjunctival incision allows preseptal dissection to the orbital rim, followed by a subperiosteal dissection of the midface. An oral incision is useful to achieve complete subperiosteal dissection and to perform the distal periostomy, which allows complete release of the midface soft tissues. A temporal incision provides access to the temporal fascia for fixation of the elevated tissues and gives the surgeon the possibility of removing redundant skin from the scalp instead of the lower eyelid. Additional posterior lamellar grafting was performed in 24 patients. There was a statistically significant reduction in the distance from the pupil centre to the lower eyelid (margin reflex distance, MRD2) 1 month after surgery (preoperative MRD2 9.62 ± 4.52 mm, postoperative MRD2 5.28 ± 2.62 mm). The ectropion and lower eyelid retraction was resolved in all patients, except for one recurrence. Midfacial elevation is a safe and effective surgical technique in the treatment of static lower eyelid malposition after chronic facial nerve palsy or posttraumatic or iatrogenic lower eyelid retraction. [ABSTRACT FROM AUTHOR]

The objective was to review our favorable experience in the use of prophylacticmidface lifts in the setting of severe midfacial trauma. A retrospective review of a consecutive series of patients undergoing prophylactic midface lifts at the time of definitive fracture repair in a County Hospital Level 1 trauma center was done. All patients undergoing midface lifts at the time of fracture repair by the senior author from July 1998 to July 2012 were included in this review. A total of 72 patients (58 males, 14 females, average age: 36.2 years) were available for review. Sixty-three patients had a minimal follow-up of at least 3 months. No complications felt to be related to the midfacial suspension were noted. There were no instances of frontal nerve paralysis or palsy. There were no patients with ectropion. Patient midfacial symmetry was evaluated by two blinded facial plastic surgeons. It was felt to be excellent in 53 patients, good in 9, fair in 1, and poor in none. The force of trauma necessary to elicit a severe midfacial fracture and the subsequent subperiosteal dissection required to expose the fractures for rigid fixation result in severe laxity of the midfacial soft tissue envelope. Failure to suspend and support these soft tissues will result in significant facial asymmetry. Prophylactic endoscopic midface suspension appears to be a safe and effective method of largely eliminating this problem and should be considered in the setting of severe midfacial fractures. [ABSTRACT FROM AUTHOR]

The subciliary incision is the most commonly used approach for lower eyelid blepharoplasty because of the advantages like ease of combining with other periocular and midface rejuvenation techniques. However, the most common reported major complication is lower lid malposition. In this article we described our subciliary dissection technique to protect the motor branches of tarsal orbicularis oculi to avoid from ectropion. [ABSTRACT FROM AUTHOR]

The aging face results in increase in laxity of the skin and the underlying supporting tissue. There is a fundamental volume loss in the face and it is most apparent in the midface. A traditional superficial musculoaponeurotic system (SMAS) rhytidectomy addresses the laxity of the face but not volume loss. Multivector high SMAS plication allows for natural excess tissue to be placed into the area of volume loss, thereby addressing midface volume loss. This technique is easy to perform, reproducible, and effective with the added benefit of helping to volumize the lower face. [ABSTRACT FROM AUTHOR]

This article describes a surgical technique using drill holes through the inferior orbital rim and fixation with permanent sutures as a functional subperiosteal midface lift and compares it to other standard midface elevation techniques. This was a retrospective, comparative, non-randomized study. Charts of all patients undergoing midface elevation between 2009 and 2013 were reviewed. Pre- and post-operative photos were graded on a scale 0 to 3 with 0 representing normal lower lid position and lid/cheek junction and 3 representing the most severe malposition. Twenty-seven patients (35 sides) underwent midface lift. Twelve sides had the subperiosteal drill hole midface lift; 9 preperiosteal with Vicryl suture fixation to periosteum; 14 subperiosteal with Endotine midface B device. All groups had similar demographics and indications for surgery. Average follow-up time was greater than 4 months in all groups. No significant complications were seen in any of the patients. The average post-operative grade of the drill hole group was 0.65 compared to 0.75 of the preperiosteal Vicryl group and 0.7 of the Endotine group. The drill hole group had the most severe pre-operative malposition. Overall, the drill hole group demonstrated the largest improvement score. The subperiosteal drill hole technique proved to be an effective method for functional midface elevation. This technique achieves adequate and durable vertical elevation without relying on the strength of the periosteum or use of a commercial device. [ABSTRACT FROM AUTHOR]

Context: Several studies showed, from the clinical point of view, the advantages of the various techniques and surgical approaches to obtain facial rejuvenation. A few studies have highlighted the satisfaction or not of patients who underwent a traditional facelift; however, a long-term follow-up study measuring patient satisfaction with midface-lift surgery has not been published yet. Aims: The aim of this study is to measure individual patient satisfaction with the midface lift, to find out from each patient his/her level of satisfaction 1 and 5 years after the operation and to compare the results to assess the benefits of the surgery. Background: Several studies showed, from a clinical point of view, the advantages of the various techniques and surgical approaches to obtain facial rejuvenation; however, a long-term follow-up study measuring patient satisfaction with midface-lift surgery has not been published yet. Materials and Methods: Between January 2005 and January 2010, 163 patients underwent a midface lift. All patients were asked to complete a standardised survey 1 and 5 years after surgery, in order to measure outcomes among facial aesthetic patients. Statistical Analysis Used: The paired t-test. Results: All patients reported an improvement as a result of the midface lift. Statistically significant differences in judgement criteria were found for malar eminence and nasojugal groove. Almost all of the patients turned out to be completely satisfied with their appearance with the new look. Conclusions: Patients were extremely satisfied with their decision to undergo a midface lift and with the outcomes and quality of life following the procedure. [ABSTRACT FROM AUTHOR]

Lagophthalmus is the inability to close the eyelids completely leading to exposed cornea (scleral show) which can result in corneal scar formation and vision loss. The skin of upper eyelid is soft and flexible, so this makes winking easier. To return the upper eyelid its soft and flexible structure, Z-plasty, VY advancement flaps, full-thickness skin grafts, and pedicle flaps are defined as treatment options. The aim of this study was to demostrate the usage of bipedicle flap and midface lift as an alternative treatment option for lagophthalmus that is related to the vertical shortness of upper eyelid developed after blepharoplasty. [ABSTRACT FROM AUTHOR]

The treatment of prominent eyes is still a challenging task. As well as the surgery, proper preoperative diagnosis differentiating between patients with and without Graves ophthalmopathy plays an important role. In functionally asymptomatic patients with Graves disease suffering from the aesthetic impairment of prominent eyes, the transpalpebral decompression by intraorbital fat removal technique has been proved to be reliable, effective, safe, and easily performed by a trained and experienced oculoplastic surgeon. This technique provides long-lasting results, leading to improvement not only in visual function but also in personal well-being and in the patient's social life, with a high benefit-to-risk ratio. The most powerful tool to treat the lower lid deformity and malar bags in patients without Graves disease is the subperiosteal midface lift. It shortens the lid--cheek junction and blends the retaining periorbital ligaments. Furthermore, it adds volume to the lower lid and gives a stable support. By the nature of the procedure, it also turns a negative into a positive vector. In experienced hands, Olivari's orbital decompression and Hester's midface lift are ideal options for the treatment of prominent eyes. [ABSTRACT FROM AUTHOR]

Summary The asymmetry created by the facial palsy is of course a cause of demand for facelift surgery. As this lifting action is specific and different from the standard procedures, 3 zones of analysis are proposed: first the frontal and temporal areas with the direct eyebrow lift, second the neck and jawline with action on the depressor anguli oris for the non-paralyzed side and the anterior sub SMAS dissection and third the midface. A new and more simple technique of concentric malar lift is proposed. The first publication on concentric malar lift was made 11 years ago. Midface rejuvenation stays very challenging. As a proof of that, many authors prefer a partial rejuvenation of mid face with fat reinjection, with no effect on skin excess, even if all the MRI studies demonstrated no fat loss with time but only fat transfer. This proves that midface lift did not acquire enough simplicity, reliability to become a standard procedure. Six hundred concentric malar lift later, a technical simplification validated with 110 patients and 2 years of follow-up is proposed. The improvement is due to a new way to pass the threads deeply on the bone, using permanent barbed sutures. This surgery becomes easier and more efficient. [ABSTRACT FROM AUTHOR]

Over the past two decades the use of endoscopes for facial rejuvenation gained wide popularity due to its reliable and reproducible results and limitation of the morbidity related to the open approaches. A thorough knowledge of the anatomy is of paramount importance to safely release all the fascial attachments while avoiding injuries to the facial nerve. The authors find the endoscopic forehead midface lift to be a reliable and safe procedure for facial rejuvenation. [ABSTRACT FROM AUTHOR]

Background: It is becoming more and more accepted that better aesthetic results can be obtained when the lower eyelid is considered as part of the midface when contemplating surgical rejuvenation. Descent of the orbicularis muscle and midface tissue causes malar bags, loss of volume over the tear-trough, apparent vertical lengthening of the lower eyelid, and an accentuation of the orbit-cheek junction. Methods: We describe a triple-layer technique that effectively corrects these problems, performed under local anesthesia and via a standard subciliary incision, to separately reposition the postseptal fat, suborbicularis oculi fat, and the musculocutaneous layer of skin and orbicularis oculi. We present a detailed analysis of the complications arising from a series of over 500 patients, in which this technique has been performed by the senior author. Results: The average patient age at the time of surgery was 51 years old (±7.9), with a median follow-up of 7 months (range 3-121). Complications were observed in 77 of 512 cases. In total, 44 of these cases required surgical reintervention under local anesthesia (rated as major complications and all reinterventions lasted <30 min) and 33 cases were treated conservatively (minor complications). Conclusion: The triple-layer midface lift is an effective way to reverse the combination of ptosis and changes in volume of the aging midface. It yields long-lasting results with a minimal risk for complications, particularly when a tarsal tuck is performed simultaneously in patients at high risk for the development of scleral show. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess quantitative changes in lower-eyelid aesthetics after a transtemporal midface lift concomitant with transconjunctival blepharoplasty and lower-eyelid skin pinch. Methods: The study enrolled 55 consecutive patients who underwent a transtemporal midface lift and concurrent transconjunctival blepharoplasty with lower-eyelid skin pinch. All the surgeries were performed over a 2-year period by the senior author (A.A.J.). Patient demographics and surgical details were recorded. Standardized digital photographs were taken at baseline and then 12 months postoperatively. These were analyzed to assess changes in the vertical height of the lower eyelid and compared using within-subject analysis. Results: The study cohort consisted of 50 women with a mean age of 54 years (range, 28-76 years). Five patients were lost to follow-up evaluation. The mean vertical height of the lower eyelid was 11.8 mm preoperatively and 9.3 mm postoperatively, giving an average difference of 2.5 mm at the 12-month follow-up assessment. The changes in lower-eyelid height were statistically significant ( p = 0.0002), and the lower eyelid-cheek contour was improved in all cases. No major complications occurred during the study period, and no revision surgery was performed. Lower-eyelid height changes did not vary significantly with patient age. Conclusions: Age-related changes to the midface are marked by increased vertical height of the lower eyelid and a concomitant appearance of infraorbital hollowing. Separation of the lower eyelid-cheek complex causes the typical double-contour deformity. To the authors' knowledge, no study to date has reported the long-term effect of a midface lift on lower-eyelid aesthetics. The transtemporal midface lift not only repositions the malar fat pad but importantly also provides significant shortening of the lower eyelid at 12 months. This results in an improved midface contour. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]