The Aging Midfacial Skeleton: Implications for Rejuvenation and Reconstruction Using Implants

E. Matros; A. Momoh; M.J. Yaremchuk

doi:10.1055/s-0029-1242037

Facial Plastic Surgery, Table of Contents

Facial Plast Surg 2009; 25(4): 252-259
DOI: 10.1055/s-0029-1242037

The Aging Midfacial Skeleton: Implications for Rejuvenation and Reconstruction Using Implants

E. Matros¹ , A. Momoh¹ ^, ² , M.J. Yaremchuk¹

¹Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
²Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas

Abstract

ABSTRACT

Traditional theories on facial aging and methods for rejuvenation focus primarily on soft tissues with ptosis as the major mechanism responsible for senescent changes. Anatomic studies demonstrate that there are also many changes to the craniofacial skeleton as patients age. Midface skeletal augmentation, using implants made of porous polyethylene, is a simple and effective method to reverse age-related changes of the facial skeleton in patients with intact occlusion. Skeletal implants correct concave morphology by increasing projection and provide a means to resuspend cheek soft tissues that have descended off a deficient bony platform. Beyond rejuvenation, skeletal implants can be used to restore facial proportions in patients with midface deficiency secondary to trauma, congenital deformity, or other pathologic states.

KEYWORDS

Implants - aging - midface - skeleton

Full Text

References

REFERENCES

1 Yousif N J, Gosain A, Sanger J R et al.. The nasolabial fold: a photogrammetric analysis. Plast Reconstr Surg. 1994; 93 70-77
2 Hamra S T. The deep-plane rhytidectomy. Plast Reconstr Surg. 1990; 86 53-61 discussion 62-63
3 Baker D C. Lateral SMASectomy. Plast Reconstr Surg. 1997; 100 509-513
4 Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg. 2007; 120 1367-1376 discussion 1377
5 Coleman S R. Facial recontouring with lipostructure. Clin Plast Surg. 1997; 24 347-367
6 Lambros V S. Hyaluronic acid injections for correction of the tear trough deformity. Plast Reconstr Surg. 2007; 120(6 Suppl) 74S-80S
7 Tallgren A. Neurocranial morphology and ageing—a longitudinal Roentgen cephalometric study of adult Finnish women. Am J Phys Anthropol. 1974; 41 285-293
8 Goldstein M. Changes in dimensions and form of the face and head with age. Am J Phys Anthropol. 1936; 22 37-89
9 Israel H. Recent knowledge concerning craniofacial aging. Angle Orthod. 1973; 43 176-184
10 Behrents R G. Growth in the Aging Craniofacial Skeleton. Ann Arbor, MI; Center for Human Growth and Development, The University of Michigan 1985
11 Bartlett S P, Grossman R, Whitaker L A. Age-related changes of the craniofacial skeleton: an anthropometric and histologic analysis. Plast Reconstr Surg. 1992; 90 592-600
12 Pessa J E, Zadoo V P, Mutimer K L et al.. Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft-tissue changes into an integrated model of midfacial aging. Plast Reconstr Surg. 1998; 102 205-212
13 Shaw Jr R B, Kahn D M. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg. 2007; 119 675-681 discussion 82-83
14 Pessa J E, Desvigne L D, Lambros V S, Nimerick J, Sugunan B, Zadoo V P. Changes in ocular globe-to-orbital rim position with age: implications for aesthetic blepharoplasty of the lower eyelids. Aesthetic Plast Surg. 1999; 23 337-342
15 Jelks G W, Jelks E B. Preoperative evaluation of the blepharoplasty patient. Bypassing the pitfalls. Clin Plast Surg. 1993; 20 213-223 discussion 224
16 Pessa J E, Chen Y. Curve analysis of the aging orbital aperture. Plast Reconstr Surg. 2002; 109 751-755 discussion 756-760
17 Kahn D M, Shaw Jr R B. Aging of the bony orbit: a three-dimensional computed tomographic study. Aesthet Surg J. 2008; 28 258-264
18 Yaremchuk M J, Israeli D. Paranasal implants for correction of midface concavity. Plast Reconstr Surg. 1998; 102 1676-1684 discussion 1685
19 Yaremchuk M J. Restoring palpebral fissure shape after previous lower blepharoplasty. Plast Reconstr Surg. 2003; 111 441-450 discussion 451-452
20 Yaremchuk M J. Infraorbital rim augmentation. Plast Reconstr Surg. 2001; 107 1585-1592 discussion 1593-1595
21 Yaremchuk M J. Improving periorbital appearance in the “morphologically prone”. Plast Reconstr Surg. 2004; 114 980-987
22 Pessa J E, Zadoo V P, Yuan C et al.. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg. 1999; 103 635-644
23 Levine R A, Garza J R, Wang P T, Hurst C L, Dev V R. Adult facial growth: applications to aesthetic surgery. Aesthetic Plast Surg. 2003; 27 265-268
24 Farkas L G, Hreczko T A, Katic M J. Craniofacial Norms in North American Caucasians from Birth to Adulthood. Appendix A Anthropometry of the Head and Face. 2nd ed. New York, NY; Raven Press 1994: 241-333
25 Yaremchuk M J. Subperiosteal and full-thickness skin rhytidectomy. Plast Reconstr Surg. 2001; 107 1045-1058
26 Mulliken J B, Godwin S L, Pracharktam N, Altobelli D E. The concept of the sagittal orbital-globe relationship in craniofacial surgery. Plast Reconstr Surg. 1996; 97 700-706
27 Rees T D, LaTrenta G S. The role of the Schirmer’s test and orbital morphology in predicting dry-eye syndrome after blepharoplasty. Plast Reconstr Surg. 1988; 82 619-625
28 Shaw Jr R B, Kahn D M. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg. 2007; 119 675-681 discussion 682-683
29 Yaremchuk M J. Making concave faces convex. Aesthetic Plast Surg. 2005; 29 141-147 discussion 148
30 Converse J M, Horowitz S L, Valauri A J, Montandon D. The treatment of nasomaxillary hypoplasia. A new pyramidal naso-orbital mazillary osteotomy. Plast Reconstr Surg. 1970; 45 527-535
31 Jackson I T, Moos K F, Sharpe D T. Total surgical management of Binder’s syndrome. Ann Plast Surg. 1981; 7 25-34
32 Whitaker L A. Aesthetic augmentation of the malar-midface structures. Plast Reconstr Surg. 1987; 80 337-346
33 Chen N T, Glowacki J, Bucky L P, Hong H Z, Kim W K, Yaremchuk M J. The roles of revascularization and resorption on endurance of craniofacial onlay bone grafts in the rabbit. Plast Reconstr Surg. 1994; 93 714-722 discussion 723-724
34 Wellisz T, Kanel G, Anooshian R. Characteristics of the tissue response to Medpor porous polyethylene implants in the human facial skeleton. J Long Term Eff Med Implants. 1993; 3 223-235
35 Rubin J P, Yaremchuk M J. Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg. 1997; 100 1336-1353

Michael J YaremchukM.D.

Division of Plastic Surgery, Massachusetts General Hospital

Wang 435, 15 Parkman Street, Boston, MA 02114

Email: myaremchuk@partners.org