Specificity of facelift surgery, including mid facelift, in case of facial palsy

Abstract

The asymmetry created by the facial palsy is of course a cause of demand for facelift surgery. As this lifting action is specific and different from the standard procedures, 3zones of analysis are proposed: first the frontal and temporal areas with the direct eyebrow lift, second the neck and jawline with action on the depressor anguli oris for the non-paralyzed side and the anterior sub SMAS dissection and third the midface. A new and more simple technique of concentric malar lift is proposed. The first publication on concentric malar lift was made 11years ago. Midface rejuvenation stays very challenging. As a proof of that, many authors prefer a partial rejuvenation of mid face with fat reinjection, with no effect on skin excess, even if all the MRI studies demonstrated no fat loss with time but only fat transfer. This proves that midface lift did not acquire enough simplicity, reliability to become a standard procedure. Six hundred concentric malar lift later, a technical simplification validated with 110patients and 2years of follow-up is proposed. The improvement is due to a new way to pass the threads deeply on the bone, using permanent barbed sutures. This surgery becomes easier and more efficient.