ABSTRACT
The subperiosteal facelift is a procedure designed to rejuvenate the upper and middle
thirds of the face. Herein we describe our experience using this technique for facial
improvement. The operative indication is significant midfacial aging. The subperiosteal
facelift is performed in a series of six consecutive steps: (1) Using either a buccal
sulcus or a subciliary incision, the subperiosteal dissection of the maxilla, zygoma,
lateral orbital rim, and anterior half of the zygomatic arch is carried out; (2)The
temporal dissection is performed over the superficial layer of the deep temporal fascia.
With endoscopic assistance, the dissection is continued over the frontal bone, lateral
orbital rim, and zygoma connecting with the anterior dissection.
(3)At the level of the temporal fascial fusion, above the arch, the sentinel vein
is identified, cauterized, and transected on its fascial side. This vein serves as
a landmark for the inferior limit of dissection; (4)The posterior arch is then exposed;
(5)The periosteum over the posterior arch is incised and entered. The subperiosteal
arch dissection is completed. A subperiosteal tunnel along the entire length of the
arch is completed; (6)The fusion of fascia superior to the midarch is then divided.
The entire subperiosteal dissection of the midface and arch is completed, making it
possible to advance the soft tissues of the midface over the bony framework of the
face.
Herein, a combination procedure using a superficial musculoaponeurotic system (SMAS)
galeal flap in the temporal area and an SMAS flap in the lower face is described.
Also, a description of fat contouring and platysma surgery is included. The overall
aesthetic results of this technique in combination with an endoscopic browlift are
reviewed as well.
KEYWORD
Subperiosteal facelift - mid facelift - zygomatic arch dissection
