Anatomic and Aesthetic Considerations in Midfacial Rejuvenation

ABSTRACT

An early sign of the aging process involves changes to the midface. The loss of the lid-cheek continuum begins with underlying laxity in the orbitomalar ligament. As the face continues to age, the malar pad drops inferomedially in position. The approach to the midface has evolved over the past 15 years with the advent of endoscopically assisted techniques of midfacial elevation. Further technology, such as thread-lifting procedures and the Endotine Midface™, have supplemented the choices for surgical correction of this facial segment. Descriptions of the different approaches to the aging midface are reviewed.

KEYWORDS

Midface - endoscopic - cheek lift - SOOF - thread lift

REFERENCES

• 1 Stuzin J M, Baker T J, Gordon H L. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging.  Plast Reconstr Surg. 1992;  89 441-449
• 2 De Cordier B C, de la Torre J I, Al-Hakeem M S et al.. Rejuvenation of the midface by elevating the malar fat pad: review of technique, cases and complications.  Plast Reconstr Surg. 2002;  110 1526-1536
• 3 Owsley J Q. Lifting the malar fat pad for correction of prominent nasolabial folds.  Plast Reconstr Surg. 1993;  91 463-474
• 4 Shorr N, Fallor M K. “Madame Butterfly” procedure: combined cheek and lateral canthal tendon procedure for post blepharoplasty “round eye” and lower eyelid retraction.  Ophthal Plast Reconstr Surg. 1985;  1 229-235
• 5 Hamra S T. Arcus marginalis release and orbital fat preservation in midface rejuvenation.  Plast Reconstr Surg. 1995;  96 354-365
• 6 Furnas D W. The retaining ligaments of the cheek.  Plast Reconstr Surg. 1989;  83 11-16
• 7 Lucarelli M J, Khwarg S I, Lemke B N et al.. The anatomy of midfacial ptosis.  Ophthal Plast Reconstr Surg. 2000;  16 7-22
• 8 Mendelson B C, Muzaffar A R, Adams W P. Surgical anatomy of the mid cheek and malar mounds.  Plast Reconstr Surg. 2002;  110 885-896
• 9 Muzaffar A R, Mendelson C B, Adams W P. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus.  Plast Reconstr Surg. 2002;  110 873-884
• 10 Gamboa G M, de la Torre J I, Vasconez L O. Surgical anatomy of the midface as applied to facial rejuvenation.  Ann Plast Surg. 2004;  52 240-245
• 11 Gosain A K, Klein M H, Sudhaker P V, Prost R W. A volumetric analysis of soft tissue changes in the aging midface using high resolution MRI: implications for facial rejuvenation.  Plast Reconstr Surg. 2005;  115 1143-1152
• 12 Goldberg R A. The three periorbital hollows: a paradigm for periorbital rejuvenation.  Plast Reconstr Surg. 2005;  116 1796-1804
• 13 Coleman S R. Facial recontouring with lipostructure.  Clin Plast Surg. 1997;  24 347-367
• 14 Terino E O. Alloplastic facial contouring by zonal principles of skeletal anatomy.  Clin Plast Surg. 1992;  19 487-510
• 15 Binder W J, Shoenrock L, Terino E O. Augmentation of the malar/submalar midface.  Facial Plast Surg Clin North Am. 1994;  2 265-283
• 16 Flowers R S. Tear trough implants for correction of tear trough deformity.  Clin Plast Surg. 1993;  20 403-415
• 17 Hamra S. The deep plane rhytidectomy.  Plast Reconstr Surg. 1990;  86 53-61
• 18 Su N N. Closed suspension mini-cheek lift to reduce the nasolabial fold: a preliminary report.  Am J Cosmetic Surg.. 1995;  12 31-34
• 19 Sasaki G H, Cohen A T. Meloplication of the malar fat pads by percutaneous cable suture technique for midface rejuvenation: outcome study (392 cases, 6 years' experience).  Plast Reconstr Surg. 2002;  110 635-654
• 20 Keller G S, Namazie A, Blackwell K, Rawnsley Khan S. Elevation of the malar fat pad with a percutaneous technique.  Arch Facial Plast Surg. 2002;  4 20-25
• 21 Patipa M. Transblepharoplasty lower eyelid and midface rejuvenation: part I. Avoiding complications by utilizing lessons learned from the treatment of complications.  Plast Reconstr Surg. 2004;  113 1459-1468