The subperiosteal, drill hole, midface lift

Intraorbital Fixation Midface Lift

BACKGROUND

Subperiosteal midface lift provides a comprehensive solution to the soft tissue component of midfacial aging. However, midfacial aging also has a skeletal component that is rarely addressed with conventional mid-facelift techniques. Moreover, many of the adverse outcomes after a mid-facelift are closely related to failures and limitations of mid-face fixation. The author's technique was designed to overcome these limitations.

OBJECTIVES

The author aimed to describe the rationale, technical details, and outcomes of the author's mid-facelift technique with intraorbital fixation.

METHODS

This study was a retrospective review of 82 nonconsecutive cases where the intraorbital fixation mid-facelift was performed by the author between September 2016 and December 2021. Patient data were obtained from patient records and standardized photography. Preoperative differences in mid-face volume were assessed utilizing the Allergan midface volume deficit scale on standardized photography.

RESULTS

The average mid-face volume deficit score significantly improved after surgery. Failure of fixation, flat midface deformity, and relapse of mid-face ptosis were not seen in any of the primary patients. Infraorbital hollow did not recur in any of the patients operated on with this technique. None of the primary patients (0/58) in this series developed ectropion or permanent lower eyelid malposition.

CONCLUSIONS

Intraorbital fixation mid-face lift is an effective and durable surgical option for the treatment of midfacial aging. The technique is applicable in problem cases such as negative vector patients, negative canthal tilt patients, male patients with large bags, and secondary lower blepharoplasties where conventional techniques tend to fail.

Advances in Face-Lift Surgical Techniques: 2016-2021

BACKGROUND

Face-lift surgery is the most crucial and constantly evolving technique of facial rejuvenation. Periodic reviews synthesizing the latest face-lift techniques may help surgeons sharpen their surgical procedures.

METHODS

A literature search was conducted of the PubMed databases using the search term "face lift" and "rhytidectomy." Articles reporting rhytidectomy of the forehead/brow, midface, lower face, and neck were included. Sixty-nine articles were selected after independent screening by three of the authors. The Oxford Centre for Evidence-based Medicine scale was used for evaluating evidence level.

RESULTS

Of the 69 candidate articles, 10 studies (15%) reported techniques of neck lifting; 10 studies (15%) introduced techniques of endoscopic brow lifting; 7 studies (10%) pertained to brow lifting without endoscopic techniques. The most frequently reported locations of rhytidectomy were the brow/forehead (20%), neck (19%), and face-neck (17%). Additionally, articles regarding Asian face-lifts (14%) have been increasing. The evidence level of the articles was generally low, with only 10 articles assessed as level 1-3 with 59 articles as level 4-5.

CONCLUSIONS

Face-lift articles with high-level evidence are still lacking. Prominently, forehead lifting and neck lifting have become upward trends of rhytidectomy in recent years, and the techniques of short-scar face-lift have been more valued.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cheek-midface lifting with lateral canthoplasy for the repair of complex iatrogenic lower eyelid ectropion

PURPOSE

To assess the efficiency and safety of cheek-midface lifting for the ophthalmoplastic reconstructive surgical repair of cicatricial lower eyelid malpositions after previously failed surgery.

METHODS

In two ophthalmoplastic clinics, 14 eyelids of 13 patients underwent transconjunctival cheek-midface lifting. In a retrospective audit, changes in margin-reflex distance 2 (MRD2), snap-back test, the position of the eyelid after surgery including improving of the presurgical scleral show, the overall patient's satisfaction as well as complications after surgery were recorded.

RESULTS

Following transconjunctival cheek-midface lifting, there was a significant improvement of MRD2, snap-back test, and the scleral show (p < 0.001, respectively). However, in three patients the scleral show persisted despite improved MRD2. All patients were satisfied with the results of the surgery. No post-surgical long-term complications were developed.

CONCLUSION

Cheek-midface lifting can be a useful technique in severe cicatricial lower eyelid ectropion after previously failed surgery and is a safe and effective reconstructive method for ophthalmic surgeons with good cosmetical results and little postoperative long-term complications.