Endoscopic Midfacial Rejuvenation

doi:10.1016/j.fsc.2015.01.006

Facial Plastic Surgery Clinics of North America

Volume 23, Issue 2, May 2015, Pages 201-208

https://doi.org/10.1016/j.fsc.2015.01.006 Get rights and content

Section snippets

Key points

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The midface and lower lid aging processes are highly interdependent, and attempts at rejuvenation must address both simultaneously.
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The aging process results from soft tissue volume loss, vertical descent of soft tissue, loss of bony projection, and laxity of the overlying skin. Each component must be considered in developing a strategy for rejuvenation.
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Endoscopic subperiosteal lift allows for an ideal vector of suspension, but has limited effect on the nasolabial fold.
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Endoscopic malar lift

Anatomy

A thorough understanding of midfacial anatomy is necessary in any attempt at midfacial rejuvenation. The boundaries of the midface are somewhat indistinct and have been defined with variability throughout the literature. The authors find it most advantageous to define the midface as an inverted triangle with the apex at the nasolabial fold. The lateral border is a line connecting this apex to the lateral canthus, and the medial border is a line connecting the apex along the nasolabial fold to

Procedure

The temporal approach subperiosteal midface lift is typically performed in conjunction with an endoscopic brow lift procedure. This allows for rejuvenation of the entire upper two-thirds of the face with a single consolidated surgical technique, while simultaneously avoiding bunching of excess skin at the lateral canthus and temporal region. This procedure is described in detail elsewhere,¹³ so here is presented the concise procedure with key points. As described, it may be performed under

Endoscopic malar fat lift

This procedure is performed in isolation or immediately prior to an endoscopic browlift. Access is provided through an incision camouflaged by the crow’s foot rhytids at the lateral canthus. Dissection is performed under the orbicularis oculi until the malar attachment of zygomaticus major is identified. Dissection progresses along the superficial surface of zygomaticus major and its SMAS investment, toward the commissura labiorum and ending at the nasolabial fold. Once the malar fat is

Discussion

The endoscopic subperiosteal midface lift is a powerful tool for addressing the aging midface (Figs. 2 and 3). The endoscopic malar fat lift represents an excellent option for patients whose primary concern is the appearance of the nasolabial fold. Both endoscopic approaches are appealing for patients, because they minimize/camouflage incisions and carry the notion of a minimally invasive surgical technique. Endoscopic techniques also appeal to surgeons by providing favorable aesthetic results

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References (18)

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Endoscopic techniques for rejuvenation of the midface
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There are more references available in the full text version of this article.

Cited by (9)

Endoscopic Preperiosteal Midface Lift Revisited
2024, Advances in Cosmetic Surgery
Morphological analysis and three-dimensional reconstruction of the SMAS surrounding the nasolabial fold
2018, Annals of Anatomy
Citation Excerpt :
The SMAS structures of the NLF may also be related to the aging changes of the NLF. Specimen-specific differences, such as the thickness of the fibro-muscular septa and the number and size of fat pads in the upper lip area, demonstrate the necessity for individual planning and performance of surgical interventions in the NLF and its surrounding regions (Engle et al., 2015; Franca Wanick et al., 2016). The facial nerve plays a central role in clinical practice particularly because its injury must be avoided during SMAS-related surgical procedures (Baker and Conley, 1979).
The superficial musculoaponeurotic system (SMAS), a structure that has been discussed with some controversy, has a complex morphological architecture.
Histological analysis was performed on tissue blocks of the nasolabial fold (NLF) collected postmortem from formalin-fixed bodies of one male and one female donor. Serial histological sections were made, stained and digitized. Three-dimensional reconstructions of the histological structures were performed. Specimen- and location-specific differences were determined. SEM analysis of the NLF tissue block was performed.
The NLF SMAS is a fibro-muscular, three-dimensional meshwork bolstered with fat cells. Two SMAS structure types were identified adjacent to the NLF. The cheek SMAS structure showed a regular, vertical and parallel alignment of the fibrous septa, building a three-dimensional meshwork of intercommunicating compartments. It changed its morphology, condensing while transiting the NLF and passing over to form an irregular structure in the upper lip region. SEM analysis demonstrated the connection between the fibrous meshwork and the fat cells. SMAS blood circulation expanded subcutaneously without perforating the fibro-muscular septa.
The NLF has a recognizable condensed cheek SMAS structure and represents the transition zone between the two SMAS types. Specimen-specific morphological differences necessitate individual planning and area-specific surgical procedures.
Midface rejuvenation surgery combining preperiosteal midcheek lift, lower blepharoplasty with orbital fat preservation and autologous fat grafting
2017, Journal of Stomatology, Oral and Maxillofacial Surgery
Citation Excerpt :
The anatomical sliding plane enables dissection with little bleeding and without trauma. It allows a short convalescence times with few edema and ecchymosis result and low complication rates [33–35]. The preperiosteal approach enables the traction exerted on the jugal soft tissues to be increased.
The aim of this study was to describe a technique for midface rejuvenation combining lower blepharoplasty, midcheek lift and autologous fat transfer.
All patients who underwent a midface rejuvenation procedure performed by the same surgeon and using a classic subciliary blepharoplasty surgical approach were identified. The technique combined three distinct procedures: lower blepharoplasty with use of a transposition flap of orbital adipose tissue in the medial and central compartment to reduce the subpalpebral bags and attenuate the palpebrojugual sulcus; midcheek lift in the preperiosteal plane with trans-osseous fixation exerting traction on the soft tissues of the cheek along several vectors; autologous fat transfer to offset the loss of volume in the target area.
Between January 2011 and December 2015, 14 patients were operated with the described technique. Long-term results were good and stable over time. Two complications in the form of ectropion were observed in the series but resolved with daily massages.
The combination of lower blepharoplasty, midcheek lift and autologous fat transfer appear to enable treatment of midface ageing. The results were satisfactory and durable, and the procedure was well tolerated. The procedures could be combined with others for the treatment of the upper and lower face during the same surgical procedure.
Periorbital Surgery. Forehead, Brow, and Midface.
2016, Facial Plastic Surgery Clinics of North America
Citation Excerpt :
The subperiosteal dissection on the maxilla and zygoma may be performed with endoscopic or direct visualization. A sublabial incision allows for increased direct visualization, but may also increase the risk of infection.26 The malar fat pad and adjacent soft tissue are then suspended via suture or fixation device to the deep temporal fascia or the periosteum of the lateral orbital rim.
Lower Blepharoplasty and Surgery of the Midface
2022, Albert and Jakobiec's Principles and Practice of Ophthalmology: Fourth Edition
Subcutaneous Face and Neck lift: A Traditional Method with Definite Effects among Asians
2021, Aesthetic Surgery Journal

View all citing articles on Scopus

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Endoscopic Midfacial Rejuvenation

Section snippets

Key points

Anatomy

Procedure

Endoscopic malar fat lift

Discussion

First page preview

Facial Plast Surg Clin North Am

Facial Plast Surg Clin North Am

The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area

Plast Reconstr Surg

The deep-plane rhytidectomy

Plast Reconstr Surg

Subperiosteal approach as an improved concept for correction of the aging face

Plast Reconstr Surg

Endoscopic full facelift

Aesthetic Plast Surg

The fat compartments of the face: anatomy and clinical implications for cosmetic surgery

Plast Reconstr Surg

The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments

Plast Reconstr Surg

The anatomy of suborbicularis fat: implications for periorbital rejuvenation

Plast Reconstr Surg