ABSTRACT
We approach the midface endoscopically through a 3 to 4 cm temporal incision. The
dissection is multiplanar: it involves a subgaleal approach to the forehead, a subfascial
approach to the temporal region, a subperiosteal approach along the zygomatic arch,
and preperiosteal approach around the orbital rim and zygomatic body. The zygomatic
cutaneous ligament is released over the origin of the zygomaticus major muscle. The
malar/orbicularis complex is then free to be resuspended along a vertical vector.
This is accomplished by suturing the mobilized free edge of the zygomatic cutaneous
ligament to the lateral orbital rim and temporalis fascia. Redundancy in the temporal
skin flap is eliminated by galeal anchorage to the temporalis muscle fascia along
a superolateral vector of traction without scalp excision. Excess lower lid fat is
removed through a transconjunctival approach preserving the integrity of the orbicularis
muscle. Fat injection, when needed, is performed to the tear through and submalar
area.
Keywords
Endoscopic - midface lift - temporal approach - retaining ligament
