Endoscopic Midfacial Rejuvenation

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

“…The malar fat pad and zygomaticus major muscle are then identified and repositioned to the temporalis using a single suture. 10 We believe this approach is an effective option for patients in their 40s to 50s who have mild-to-moderate midface ptotic compartments. However, because the subperiosteal lift reapproximates and tightens the zygomaticus major muscle (which is attached to the nasolabial fold), the facial plastic surgeon should be aware of the potential for deepening of the nasolabial fold in patients with significant malar fat pad ptosis.…”

“…In addition to the benefit of hiding the scar, the surgeon can be confident that he or she is posterior to Pitanguy and Ramos line that states the course of the nerve runs from 0.5 cm below the tragus to 1.5 cm superior to the lateral eyebrow. 9,10 Tenotomy scissors are used to dissect down to the superficial layer of the deep temporal fascia and blunt dissection is carried anteriorly to the lateral canthus and zygomatic arch. As Lee and Quatela state, a bipolar can be used to cauterize small perforating vessels but should be done with caution by pressing down on the temporalis rather than superficially to prevent injury to the frontal branch of the facial nerve.…”

A minimally invasive midface suspension

“…These include gravitational pull, repetitive facial animation, laxity of the retaining ligaments, and loose attachment to the underlying SMAS. The effects of this descent have also been well described, such as hollowing of the infraorbital rim, deepening of the nasolabial folds, and the formation of jowls [1][2][3][4][5][6][7][8] . Myriad techniques have been used to rejuvenate the midface, ranging from open surgeries with extensive dissection to closed procedures with barbed sutures and zero dissection [2,3,[8][9][10][11] .…”

“…It is superficial to the superficial muscular aponeurotic system (SMAS) [1] . This triangular structure has its apex located at the oral commissure; the lateral border is a line from the apex to the lateral canthus; the medial border is a line from the apex to the medial canthus; and the superior border is a horizontal line that runs along the inferior aspect of the lower eye [2] .…”

“…Numerous studies have described the etiology of ptosis of the malar fat pad [1][2][3][4][5][6][7][8] . These include gravitational pull, repetitive facial animation, laxity of the retaining ligaments, and loose attachment to the underlying SMAS.…”