BackgroundMalar mounds may be accentuated by chronic lid edema, with the development from malar edema to malar mounds and finally to malar festoons. Because standard techniques do not seem effective and not specifically proposed for the treatment of malar festoons, subperiosteal vertical upper-midface lift associated with lower blepharoplasty overcomes these shortcomings.MethodsTwelve patients (3 males and 9 females, age = 47 ± 6 years) underwent video-assisted endoscopic subperiosteal vertical upper-midface lift (SUM-lift) in conjunction with a lower blepharoplasty between 2006 and 2007 for treatment of malar festoons. This includes simultaneous lower blepharoplasties and video-assisted transtemporal subperiosteal and sub-SMAS tissue release.ResultsAll patients healed uneventfully without any major postoperative problems. The surgical outcome was evaluated according to the analysis of photographs obtained before and after surgery and the analysis of pre- and postoperative measurements. The technique we used (SUM-lift) achieved a significant rejuvenation of the midface and the malar festoons.ConclusionSubperiosteal vertical midface lift resuspends and redrapes the facial network that originates at the level of the orbital rim. It seems to improve the permeability characteristics of the malar septum in the treatment of malar festoons and malar mounds by freeing the cheek tissue from underlying bone and redraping the malar septum. It is a reliable technique to improve malar mounds, palpebral bags, or festoons.

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To improve brow ptosis and forehead rhytids, minimal invasive surgery has successfully been applied more recently. Clinical studies have revealed that inadequate fixation for anchoring a transposed released soft tissue will result in a loss of suspension of the lateral eyebrow. Therefore, we evaluated the results of eyebrow position in a series of endoscopic-assisted eyebrow lift cases by comparing broad base of fixation with an Endotine device versus conventional single-point tissue fixation with suture loop fixation of the soft forehead tissue. Between 2003 and 2005, 47 patients (12 males and 35 females, age 38.5 +/- 6.2 years)) underwent eyebrow lift and a forehead plasty. In one group, which consists of 25 patients (6 males and 19 females, age 36.5 +/- 5.1 years), soft tissue fixation of the elevated forehead was performed conventionally with one suture loop on each side that passed through the galea-periosteum and anchored to the cranial bone (bone tunnels). In the other group of 22 patients (4 males and 18 females, age 39.3 +/- 6.4 years), the elevated forehead was anchored to Endotine 3.5 version. Despite the fact that 6 months after surgery, drooping of the lateral brow position was observed, with a mean of 2.3 +/- 0.8 mm, in the overall cases 12 months after surgery, differences in the position of medial third of the eyebrow were noted between these groups. In the Endotine group, the medial third of the eyebrow portion stayed more stable at its transposed position and was in mean 1.5 +/- 0.6 mm higher compared with the suture soft-fixed group. The results confirmed that Endotine enhances soft tissue suspension by allowing better distribution of tension over multiple points over time and thereby supports re-adherence strength of the transpose medial flap forehead to the frontal bone. For minimizing a relapse of the elevated lateral eyebrow portion after adequate dissection and tissue release, suspension of the lateral soft forehead tissue is paramount. It should be located between the temporoparietalis fascia and the deep temporal fascia, with extensive tension after resection of temporal fascia window additionally supported by reabsorbable threads or gore tex sutures.

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