Periorbital Surgery: Forehead, Brow, and Midface

Buccal Fat Pad Excision for Facial Rejuvenation: The Relationship Between the Resected Position and Its Influence on Facial Shape and Volume

Background

To date, facelift surgery has been the most common choice for those seeking antiaging solutions. However, buccal fat pad (BFP) excision has also been utilized recently.

Objectives

An interrelation between the BFP, resection area, and its influence on facial shape and volume is scrutinized to achieve "tailor-made" outcomes in patients with BFP-related symptoms.

Methods

Patients were categorized into 2 groups: Type I with a bottom-heavy face and Type II with ptotic lower cheeks, typically seen in older people. The lower face was divided into upper and lower segments bilaterally. Then, the relationship between the resected position of the BFP and its influence on facial shape and volume was studied.

Results

BFP excision was performed for 133 patients (118 females and15 males) between May 2020 and June 2022. Sixty-one of these patients were categorized into Type I (39 patients) and Type II (22 patients) and were followed up for 12 months postoperatively. The volume of all lower facial segments decreased postoperatively in both types of patients. The variation rate of the upper segment volume in Type II patients was less than that in Type I patients. The results were consistent with a technique that did not remove large chunks of the BFP from the upper segment in Type II patients.

Conclusions

BFP excision is an effective facial rejuvenation treatment if proper candidates are selected. To improve the accuracy of BFP excision, the relationship between the resected position of the BFP and its influence on facial shape and volume should be well understood.

Level of Evidence 3

Mastering Midface Injections

Injectable filler is one of the most common cosmetic procedures performed annually. An aging face shows a characteristic loss of volume in the deep fat pads of the midface. The goal of midfacial rejuvenation with injectable filler is to restore lost volume, with the suborbicularis fat pad and deep medial cheek fat being the most critical areas. Filler can be instilled here with a cannula or needle with successful outcomes. However, this procedure is not without complications if proper technique and underlying anatomy are not respected.

Eyebrow lifting with barbed threads: A simple, safe, and effective ambulatory procedure

INTRODUCTION

Changes in brow positioning are one of the first facial aging signs. A more beautiful and younger look can be achieved by repositioning the tissues involved in brow descent and sagging eyelids.

METHODS

We report the outcome of eyebrow thread lifting in a series of patients who came to our clinic to improve their gaze. Response to treatment was assessed at 6- and 12-months using FACE-Q^™ upperlids and eyebrow/forehead scales.

RESULTS

A total of 38 patients with mild-to-moderate brow ptosis or without ptosis underwent eyebrow thread lifting (mean age 35.5, all female). No serious complications were observed during or after treatment. All patients were satisfied with the outcome of the intervention. Mean FACE-Q^™ scores improved at six months compared with baseline. A statistically significant increase in mean FACE-Q^™ scores was still seen at 12 months and was more evident in younger women. Patients were able to go back to their daily lives the day after the procedure.

CONCLUSION

Eyebrow thread lifting is a minimally invasive procedure able to overcome mild-to-moderate ptosis with excellent aesthetic results. In the absence of ptosis, thread lifting is a good choice to reposition the brow and improve the gaze. The technique is simple to perform and safe.

Direct Browlift

Direct browlifting comprises various techniques to lift the brows using incisions on or around the brows. The classic direct browlift involves removing an ellipse of skin and subcutaneous tissue within or just above the brow cilia. However, the technique can be modified to address only lateral brow ptosis, to place the incision in the midforehead or the eyelid crease, and to place the incisions in different areas during bilateral surgery to attempt to improve symmetry. Careful attention to incision location, closure technique, and use of postoperative therapies can allow for nearly invisible scars in some cases.

Aesthetic Values of the Buccal Fat Pad Excision in Middle Aged Patients

Background

Despite buccal fat pad (BFP) excision being an effective and established surgery for the reduction of lower facial volume, there are very few reports explaining a systematic and reliable method for this surgery. The author will demonstrate one method for BFP excision surgery with some important tips and information on the procedure.

Objectives

The author performed BFP excision surgery for patients seeking facial slimming or improvement of the ptotic lower face. To know the true efficacy of this surgery, objective facial scales were compared preoperatively and postoperatively.

Methods

Preoperative and postoperative three-dimensional (3D) pictures were taken, and numerical data for cheek volume and horizontal lower facial length were obtained from 3D picture analysis. The data were statistically analyzed to reveal postoperative improvements.

Results

The average age of the patients was 54.23 ± 10.31 years old. BFP excision surgery took 60.30 ± 5.93 minutes. Preoperative and 12 months postoperative body weight was 52.3 ± 6.84 and 52.3 ± 6.75 kg, respectively. The average weights for excised BFP were 1.74 ± 0.72 g right and 1.59 ± 0.71 g left. The average of preoperative lower facial volumes was 209.36 ± 30.22 mL right and 209.03 ± 30.13 mL left. The average 12 months postoperative lower facial volumes were 205.00 ± 30.37 mL right and 204.43 ± 30.02 mL left. The results showed a significant difference in both sides (P < 0.01). The average of horizontal lower facial lengths was 238.73 ± 10.87 mm preoperatively and 235.06 ± 10.57 mm 12 months postoperatively. The results affirm that there is a significant difference (P < 0.01).

Conclusions

A properly executed BFP excision can achieve distinct facial slimming for the capacious face and can also contribute to improving lower face sagging due to BFP ptosis in middle-aged patients.

Level of Evidence: 4

Safety and Efficacy of a Trans-Eyelid Facial Rejuvenation Surgery Combining Partial Repositioning of Orbital Fat and Midface Lift in Chinese Patients: A Prospective Case Series

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.