Management of the Midface During Facial Rejuvenation

ABSTRACT

The endoscopic midface lift procedure has evolved from experience with postreduction soft tissue repair after facial fracture fixation. The procedure elevates and repositions midface soft tissue, which descends with facial aging; as well, it can correct periorbital congenital abnormalities, such as exorbitism and lateral canthal displacement. The procedure has been refined by the senior author to employ a temporal endoscopic approach alleviating the need for a lower eyelid incision. The plane is sub-SMAS (superficial muscular aponeurotic system) within the pre-zygomatic space with release of the zygo-orbicular ligament and the malar retaining ligament. Using an endoscopically placed suture in the malar retaining ligament, the midface and orbicularis oculi are elevated en bloc, with additional selective sutures applied for specific lower eyelid and cheek morphology. Ancillary lower eyelid procedures including skin resurfacing, skin excision, soft tissue augmentation, and a transblepharoplasty septal reset can all be safely applied to the lower eyelid in the same operative setting. All procedures are technically advanced though once executed deliver an exact correction of the midface, which can be combined with both brow and lower face rejuvenation. The procedure offers limited recovery time and few complications as the facial surgeon becomes facile with the technique.

KEYWORDS

Endoscopic midface lift - midface rejuvenation - lower eyelid rejuvenation

REFERENCES

• 1 Byrd H S, Andochick S E. The deep temporal lift: a multiplanar, lateral brow, temporal, and upper face lift.  Plast Reconstr Surg. 1996;  97 928-937
• 2 Byrd H S, Salomon J. Endoscopic midface rejuvenation. In: Culbertson JH Operative Techniques in Plastic Surgery. Philadelphia, PA; WB Saunders 1998: 138-144
• 3 Byrd H S, Burt J D. Achieving aesthetic balance in the brow, eyelids, and midface.  Plast Reconstr Surg. 2002;  110 926-933 discussion 934-939
• 4 Sullivan P K, Salomon J A, Woo A S, Freeman M B. The importance of the retaining ligamentous attachments of the forehead for selective eyebrow reshaping and forehead rejuvenation.  Plast Reconstr Surg. 2006;  117 95-104
• 5 Mendelson B C, Muzaffar A R, Adams Jr W P. Surgical anatomy of the midcheek and malar mounds.  Plast Reconstr Surg. 2002;  110 885-896 discussion 897-911
• 6 Lowe III J B, Cohen M, Hunter D A, Mackinnon S E. Analysis of the nerve branches to the orbicularis oculi muscle of the lower eyelid in fresh cadavers.  Plast Reconstr Surg. 2005;  116 1743-1749 discussion 1750-1751
• 7 Hamra S T. Frequent face lift sequelae: hollow eyes and the lateral sweep: cause and repair.  Plast Reconstr Surg. 1998;  102 1658-1666