Subperiosteal face lift: A mid face degloving technique through an intraoral approach

Abstract

The ideal face lift operation could be characterized as a procedure that involves no danger to the facial nerve branches; results in durable elimination or marked decrease of jowling and nasolabial fold depth; results in enhancement of the malar prominence; causes no distortion, creasing, or “tight masking”; involves no risk of flap ischemia; and is marked by a short, fast, and painless recovery with minimal swelling and bruising. The search for the ideal face lift, which has consumed about half a century, has been far reaching, beginning with procedures that involved only modest skin dissections and progressing to extensive skin dissections, platysma flaps, superficial musculoaponeurotic system (SMAS) flaps, complete subperiosteal deglovings, deep plain dissections, suborbicularis oculi fat (SOOF) suspensions of various designs, and a recent return to extensive skin dissections. I have tried most of these techniques but found that they failed to meet an acceptable number of the aforementioned criteria, and thus I abandoned extensive subperiosteal dissections and SOOF suspension. Instead I began performing a limited mid face degloving technique by means of an intraoral approach, which requires no suspension sutures, combined with a tight SMAS plication. Of all the techniques I have used, this approach has come closest to approximating the ideal face lift procedure. The usual procedures should be used to screen patients, including medical history, physical examination, and laboratory tests. In addition, all patients must be instructed not to take vitamin E and nonsteroidal anti-inflammatory agents to prevent bleeding problems. Whereas most textbooks indicate that 7 …