A Comprehensive Approach to Midface Rejuvenation: Our Philosophy, Algorithm, and Surgical Technique

Abstract

With a greater understanding of the aging process and relevant anatomy, the facial plastic surgeon has an expansive armamentarium of options for midface rejuvenation. Upon reflection, our practice has evolved over the years and only recently found a select number of interventions that have consistently produced excellent results. In this article, we discuss the steps needed to establish an effective patient relationship, present an algorithm on how to approach midface rejuvenation, describe our surgical technique, and review the attributes and liabilities of each procedure.

Trials, Tribulations, and Techniques for Transitioning to an Extended Deep Plane Facelift for All Patients: Insight from a Very Experienced Surgeon's Perspective

“…Prior to adopting the extended deep plane lift, several techniques were employed to attempt to achieve an increase in upper midfacial volume and shortening of the lower eyelid-hallmarks of the youthful female face. 4 Combining the SMAS lift with fat grafting to the midface and lower lid complex produced a result that was often very good, but somewhat unpredictable and occasionally short lived. Fat grafting also increased edema, bruising, and downtime for patients seeking a streamlined experience.…”

“…The subperiosteal midface lift via the temporal brow approach was a very familiar dissection due to years of trauma experience and offered very good results, but again the result would frequently begin to decline after 3 to 5 years. 4 Alternatively, some surgeons sought to suspend the midface directly through a transconjunctival or lower lid approach. The senior author never adopted this approach and has seen many referrals with significant lid malposition complications from these attempts elsewhere.…”