A Novel, Minimally Invasive Festoon Surgery: Mini Incision Direct Festoon Access, Cauterization, and Excision (MIDFACE): A 12 Year Analysis.

Abstract

Surgical festoon management often entails aggressive dissection, flaps, unsightly scars, prolonged recovery, and high recurrence rates. The author presents outcomes with subjective and objective evaluation of an office-based novel, minimally invasive (1 cm incision) festoon repair: MIDFACE (Mini-Incision Direct Festoon Access, Cauterization and Excision). Charts of 75 consecutive patients from 2007 to 2019 were evaluated. Photographs of 39 who met inclusionary criteria were evaluated by 3 expert physician graders for festoon and incision visibility (339 randomly scrambled preoperative and postoperative photographs taken with and without flash and from 4 different views-close-up, profile, full-frontal, and worm's eye) using paired student t-tests and Kruskal-Wallis tests for statistical evaluation. Surveys returned by 37 of 75 patients were evaluated for patient satisfaction and possible contributing factors to festoon formation or exacerbation. There were no major complications in the 75 patients who underwent MIDFACE. Physician grading of 39 patients (78 eyes, 35 women; 4 men; mean 58±7.7 years) demonstrated statistically significant sustained improvement in festoon score postoperatively up to 12 years regardless of view or flash. Incision scores were the same pre- and post-op, indicating incisions could not be detected by photography. Average patient satisfaction was 9.5 on a Likert scale of 0-10. Possible factors for festoon formation or exacerbation included genetic (51%), pets (51%), prior hyaluronic acid fillers (54%), neurotoxin (62%), facial surgery (40%), alcohol (49%), allergies (46%), and sun exposure (59%). MIDFACE repair results in sustained improvement of festoons with an office-based, minimally invasive procedure with high patient satisfaction, rapid recovery, and low recurrence.