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Facial Plast Surg 2009; 25(4): 252-259
DOI: 10.1055/s-0029-1242037
© Thieme Medical Publishers

The Aging Midfacial Skeleton: Implications for Rejuvenation and Reconstruction Using Implants

E. Matros1 , A. Momoh1 , 2 , M.J. Yaremchuk1
  • 1Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  • 2Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Publication History

Publication Date:
18 November 2009 (online)

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ABSTRACT

Traditional theories on facial aging and methods for rejuvenation focus primarily on soft tissues with ptosis as the major mechanism responsible for senescent changes. Anatomic studies demonstrate that there are also many changes to the craniofacial skeleton as patients age. Midface skeletal augmentation, using implants made of porous polyethylene, is a simple and effective method to reverse age-related changes of the facial skeleton in patients with intact occlusion. Skeletal implants correct concave morphology by increasing projection and provide a means to resuspend cheek soft tissues that have descended off a deficient bony platform. Beyond rejuvenation, skeletal implants can be used to restore facial proportions in patients with midface deficiency secondary to trauma, congenital deformity, or other pathologic states.

KEYWORDS

Implants - aging - midface - skeleton

REFERENCES

  • 1 Yousif N J, Gosain A, Sanger J R et al.. The nasolabial fold: a photogrammetric analysis.  Plast Reconstr Surg. 1994;  93 70-77
    CrossrefPubMedGoogle Scholar
  • 2 Hamra S T. The deep-plane rhytidectomy.  Plast Reconstr Surg. 1990;  86 53-61 discussion 62-63
    CrossrefPubMedGoogle Scholar
  • 3 Baker D C. Lateral SMASectomy.  Plast Reconstr Surg. 1997;  100 509-513
    CrossrefPubMedGoogle Scholar
  • 4 Lambros V. Observations on periorbital and midface aging.  Plast Reconstr Surg. 2007;  120 1367-1376 discussion 1377
    CrossrefPubMedGoogle Scholar
  • 5 Coleman S R. Facial recontouring with lipostructure.  Clin Plast Surg. 1997;  24 347-367
    PubMedGoogle Scholar
  • 6 Lambros V S. Hyaluronic acid injections for correction of the tear trough deformity.  Plast Reconstr Surg. 2007;  120(6 Suppl) 74S-80S
    CrossrefPubMedGoogle Scholar
  • 7 Tallgren A. Neurocranial morphology and ageing—a longitudinal Roentgen cephalometric study of adult Finnish women.  Am J Phys Anthropol. 1974;  41 285-293
    CrossrefPubMedGoogle Scholar
  • 8 Goldstein M. Changes in dimensions and form of the face and head with age.  Am J Phys Anthropol. 1936;  22 37-89
    CrossrefPubMedGoogle Scholar
  • 9 Israel H. Recent knowledge concerning craniofacial aging.  Angle Orthod. 1973;  43 176-184
    PubMedGoogle Scholar
  • 10 Behrents R G. Growth in the Aging Craniofacial Skeleton. Ann Arbor, MI; Center for Human Growth and Development, The University of Michigan 1985
    PubMedGoogle Scholar
  • 11 Bartlett S P, Grossman R, Whitaker L A. Age-related changes of the craniofacial skeleton: an anthropometric and histologic analysis.  Plast Reconstr Surg. 1992;  90 592-600
    CrossrefPubMedGoogle Scholar
  • 12 Pessa J E, Zadoo V P, Mutimer K L et al.. Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft-tissue changes into an integrated model of midfacial aging.  Plast Reconstr Surg. 1998;  102 205-212
    CrossrefPubMedGoogle Scholar
  • 13 Shaw Jr R B, Kahn D M. Aging of the midface bony elements: a three-dimensional computed tomographic study.  Plast Reconstr Surg. 2007;  119 675-681 discussion 82-83
    Google Scholar
  • 14 Pessa J E, Desvigne L D, Lambros V S, Nimerick J, Sugunan B, Zadoo V P. Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids.  Aesthetic Plast Surg. 1999;  23 337-342
    CrossrefPubMedGoogle Scholar
  • 15 Jelks G W, Jelks E B. Preoperative evaluation of the blepharoplasty patient. Bypassing the pitfalls.  Clin Plast Surg. 1993;  20 213-223 discussion 224
    PubMedGoogle Scholar
  • 16 Pessa J E, Chen Y. Curve analysis of the aging orbital aperture.  Plast Reconstr Surg. 2002;  109 751-755 discussion 756-760
    CrossrefPubMedGoogle Scholar
  • 17 Kahn D M, Shaw Jr R B. Aging of the bony orbit: a three-dimensional computed tomographic study.  Aesthet Surg J. 2008;  28 258-264
    CrossrefPubMedGoogle Scholar
  • 18 Yaremchuk M J, Israeli D. Paranasal implants for correction of midface concavity.  Plast Reconstr Surg. 1998;  102 1676-1684 discussion 1685
    CrossrefPubMedGoogle Scholar
  • 19 Yaremchuk M J. Restoring palpebral fissure shape after previous lower blepharoplasty.  Plast Reconstr Surg. 2003;  111 441-450 discussion 451-452
    PubMedGoogle Scholar
  • 20 Yaremchuk M J. Infraorbital rim augmentation.  Plast Reconstr Surg. 2001;  107 1585-1592 discussion 1593-1595
    CrossrefPubMedGoogle Scholar
  • 21 Yaremchuk M J. Improving periorbital appearance in the “morphologically prone”.  Plast Reconstr Surg. 2004;  114 980-987
    CrossrefPubMedGoogle Scholar
  • 22 Pessa J E, Zadoo V P, Yuan C et al.. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls.  Plast Reconstr Surg. 1999;  103 635-644
    CrossrefPubMedGoogle Scholar
  • 23 Levine R A, Garza J R, Wang P T, Hurst C L, Dev V R. Adult facial growth: applications to aesthetic surgery.  Aesthetic Plast Surg. 2003;  27 265-268
    CrossrefPubMedGoogle Scholar
  • 24 Farkas L G, Hreczko T A, Katic M J. Craniofacial Norms in North American Caucasians from Birth to Adulthood. Appendix A Anthropometry of the Head and Face. 2nd ed. New York, NY; Raven Press 1994: 241-333
    PubMedGoogle Scholar
  • 25 Yaremchuk M J. Subperiosteal and full-thickness skin rhytidectomy.  Plast Reconstr Surg. 2001;  107 1045-1058
    CrossrefPubMedGoogle Scholar
  • 26 Mulliken J B, Godwin S L, Pracharktam N, Altobelli D E. The concept of the sagittal orbital-globe relationship in craniofacial surgery.  Plast Reconstr Surg. 1996;  97 700-706
    CrossrefPubMedGoogle Scholar
  • 27 Rees T D, LaTrenta G S. The role of the Schirmer’s test and orbital morphology in predicting dry-eye syndrome after blepharoplasty.  Plast Reconstr Surg. 1988;  82 619-625
    CrossrefPubMedGoogle Scholar
  • 28 Shaw Jr R B, Kahn D M. Aging of the midface bony elements: a three-dimensional computed tomographic study.  Plast Reconstr Surg. 2007;  119 675-681 discussion 682-683
    Google Scholar
  • 29 Yaremchuk M J. Making concave faces convex.  Aesthetic Plast Surg. 2005;  29 141-147 discussion 148
    CrossrefPubMedGoogle Scholar
  • 30 Converse J M, Horowitz S L, Valauri A J, Montandon D. The treatment of nasomaxillary hypoplasia. A new pyramidal naso-orbital mazillary osteotomy.  Plast Reconstr Surg. 1970;  45 527-535
    CrossrefPubMedGoogle Scholar
  • 31 Jackson I T, Moos K F, Sharpe D T. Total surgical management of Binder’s syndrome.  Ann Plast Surg. 1981;  7 25-34
    CrossrefPubMedGoogle Scholar
  • 32 Whitaker L A. Aesthetic augmentation of the malar-midface structures.  Plast Reconstr Surg. 1987;  80 337-346
    CrossrefPubMedGoogle Scholar
  • 33 Chen N T, Glowacki J, Bucky L P, Hong H Z, Kim W K, Yaremchuk M J. The roles of revascularization and resorption on endurance of craniofacial onlay bone grafts in the rabbit.  Plast Reconstr Surg. 1994;  93 714-722 discussion 723-724
    CrossrefPubMedGoogle Scholar
  • 34 Wellisz T, Kanel G, Anooshian R. Characteristics of the tissue response to Medpor porous polyethylene implants in the human facial skeleton.  J Long Term Eff Med Implants. 1993;  3 223-235
    PubMedGoogle Scholar
  • 35 Rubin J P, Yaremchuk M J. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature.  Plast Reconstr Surg. 1997;  100 1336-1353
    CrossrefPubMedGoogle Scholar

Michael J YaremchukM.D. 

Division of Plastic Surgery, Massachusetts General Hospital

Wang 435, 15 Parkman Street, Boston, MA 02114

Email: myaremchuk@partners.org

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