Endoscopic Subperiosteal Midface Lift Research Articles

Evolution in Techniques for Endsocopic Brow Lift with Deep Temporal Fixation Only and Lower Blepharoplasty-Transconjunctival Fat Repositioning

As we become more confident with our surgical skills following our fellowship training, some of our approaches and techniques will be modified or changed. My primary evolutionary change involves procedures of the upper third of the face, primarily the brow lift and treatment of lower eyelid fat techniques. Traditional methods of forehead and brow rejuvenation, such as coronal, pretrichal, and direct brow lifts, have provided facial plastic surgeons with effective brow elevation for many years. In the past decade, the endoscopic brow lift has rapidly become accepted as part of the surgical armamentarium and is frequently the technique of choice. In general, the temporal dissection, temporal fixation, forehead subperiosteal or subgaleal dissection with release, and treatment to the brow depressor musculature have been standardized. Methods of bony fixation remain a controversial topic as there are numerous methods. We advocate deep temporal fixation only without bone fixation to achieve effective, long-term brow elevation. Traditionally, lower eyelid herniated fat is removed, which may cause a sunken or hollow lid appearance, especially in patients with a tear trough deformity (nasojugal groove). Lower eyelid transconjunctival fat repositioning, defined as the subperiosteal repositioning of the medial and central lower eyelid herniated orbital fat into the nasojugal fold, may prevent the surgical, hollow lower eyelid appearance while treating the herniated fat. Fat repositioning may be combined with an endoscopic subperiosteal midface-lift, transcutaneous skin pinch, and transconjunctival orbicularis oculi excision. This technique offers a powerful tool in the surgical armamentarium of the facial plastic surgeon.

Reply to Dr. R. C. Kerstenʼs Letter on “Endoscopic Subperiosteal Midface Lift”

Reply to Dr. R. C. Kerstenʼs Letter on “Endoscopic Subperiosteal Midface Lift”

Re: Endoscopic Subperiosteal Midface Lift—Surgical Technique With Indications and Outcomes

Re: Endoscopic Subperiosteal Midface Lift—Surgical Technique With Indications and Outcomes

Graft Contraction

In Brief Purpose To compare graft contraction rates of acellular dermis versus hard palate mucosa when used as free spacer grafts in lower eyelid surgery and to provide clinical outcome data. Methods A prospective, nonrandomized clinical trial involving the placement of 19 spacer grafts in the lower eyelids of 14 patients was performed. Indications for spacer graft placement included lower eyelid retraction and mildly contracted socket. Patients with lower eyelid retraction also underwent an endoscopic subperiosteal midface lift. For all procedures, the height of each graft was measured during and after surgery. The amount of contraction was measured for each graft, and a mean was calculated for each spacer material. The clinical success was evaluated for all procedures, based on improvement of the functional concern being addressed. Results The mean graft contraction rate was 57% for the acellular dermis and 16% for the hard palate mucosal grafts (P <0.005). Of the 7 procedures using acellular dermis for lower eyelid retraction, 6 were considered a success, and 1 was considered a partial success. Of the 6 procedures using hard palate for lower eyelid retraction, 5 were considered a success, and 1 was considered a failure unrelated to the graft. Of the 5 procedures with acellular dermis used for mildly contracted socket, 2 were considered a success, 2 were considered a partial success, and 1 was considered a failure because of graft contraction. The one case using hard palate for mildly contracted socket was considered a success. Conclusions Acellular dermis contracts significantly more than hard palate mucosa when used as a lower eyelid spacer graft. Acellular dermis and hard palate mucosa were both associated with a high rate of clinical success in all categories except for patients with a mildly contracted socket who received acellular dermis; more than 60% of these patients (n=5) had only partial success or failure caused by graft contraction. Acellular dermis has a significantly greater contraction rate than hard palate mucosa in lower eyelid surgery, although clinical success may be achieved with both materials.

Transblepharoplasty Endoscopic Subperiosteal Midface Lift by John V. Williams, M.D.

Received for publication July 23, 2002. T. Roderick Hester, Jr., M.D. The Palisades Suite 640 3200 Downwood Circle Atlanta, Ga. 30327[email protected]

Transblepharoplasty endoscopic subperiosteal midface lift.

The use of endoscopy in the transblepharoplasty midface lift is essential for preventing the complications of facial nerve injury and bleeding. Complete observation allows precise dissection and release of all structures in the composite flap. This technique fully preserves the zygo-orbicular nerve plexus and prevents denervation of the orbicularis oculi and zygomaticus muscles. Blind dissection has a significant probability of denervation of the entire zygo-orbital muscle complex, and avulsion of the zygomaticofacial vessels, with associated postoperative bleeding complications. The modification involving suturing of the "vest" of the combined lateral orbital periosteal and superficial layers of the deep temporal fascia over the elevated "pants" of the orbicularis periosteal flap provides very secure fixation for suspension of the lower eyelid and midface. The use of slowly absorbable polydioxanone sutures for this technique prevents the problems caused by permanent sutures beneath the very thin skin of the lateral canthal area. Careful trimming of the prominent roll of the orbicularis muscle that often develops with suspension eliminates the uneven contour and yields a smooth lower lid appearance. The details and modifications described should decrease the complications and morbidity that can occur with this procedure and provide for a more precise and reliable procedure for rejuvenation of the lower eyelid and midface.

Transblepharoplasty Endoscopic Subperiosteal Midface Lift

AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK AMERICAN SOCIETY OF PLASTIC SURGEONS PLASTIC & RECONSTRUCTIVE SURGERY PRS GLOBAL OPEN ASPS EDUCATION NETWORK

Endoscopic subperiosteal midface lift: surgical technique with indications and outcomes.

To review the surgical technique of the endoscopic subperiosteal midface lift and present our clinical outcome in 22 consecutive patients. We retrospectively evaluated the clinical outcomes of 39 endoscopic subperiosteal midface lifts in 22 consecutive patients. Of the 39 sides, 21 had a lower eye conjunctival spacer graft inserted (15 hard palate mucosal graft, 6 AlloDerm). The success of the procedure was graded based on the aesthetic and functional results. Subjective and objective assessments were made using history, examination, and photos. Results for the clinical outcome were graded as excellent, good, fair, or poor. Among the 39 sides, indications for the procedure included facial rejuvenation (41%), postblepharoplasty lower eyelid retraction (26%), eyelid retraction secondary to midfacial ptosis (15%), severe cicatricial ectropion (13%), and paralytic ectropion secondary to 7th nerve palsy (5%). The operating surgeons evaluated the clinical outcome as "excellent" in 24 sides (61%), "good" in 10 sides (26%), "fair" in 2 sides (5%), and "poor" in 3 sides (8%). The procedure was successful at increasing malar projection, improving lower eyelid fullness, and elevating the lower eyelid in cases of lower eyelid retraction. The procedure was less effective in decreasing the prominence of the deep nasolabial fold. The endoscopic subperiosteal midface lift is an effective method for elevating the midface. A more youthful appearance is achieved with the procedure, and when necessary, recruitment of anterior lamella allows elevation of the lower eyelid to correct retraction.

Endoscopic Subperiosteal Midface Lift

To review the surgical technique of the endoscopic subperiosteal midface lift and present our clinical outcome in 22 consecutive patients.We retrospectively evaluated the clinical outcomes of 39 endoscopic subperiosteal midface lifts in 22 consecutive patients. Of the 39 sides, 21 had a lower eye conjunctival spacer graft inserted (15 hard palate mucosal graft, 6 AlloDerm). The success of the procedure was graded based on the aesthetic and functional results. Subjective and objective assessments were made using history, examination, and photos.Results for the clinical outcome were graded as excellent, good, fair, or poor. Among the 39 sides, indications for the procedure included facial rejuvenation (41%), postblepharoplasty lower eyelid retraction (26%), eyelid retraction secondary to midfacial ptosis (15%), severe cicatricial ectropion (13%), and paralytic ectropion secondary to 7th nerve palsy (5%). The operating surgeons evaluated the clinical outcome as "excellent" in 24 sides (61%), "good" in 10 sides (26%), "fair" in 2 sides (5%), and "poor" in 3 sides (8%). The procedure was successful at increasing malar projection, improving lower eyelid fullness, and elevating the lower eyelid in cases of lower eyelid retraction. The procedure was less effective in decreasing the prominence of the deep nasolabial fold.The endoscopic subperiosteal midface lift is an effective method for elevating the midface. A more youthful appearance is achieved with the procedure, and when necessary, recruitment of anterior lamella allows elevation of the lower eyelid to correct retraction.

Endoscopic subperiosteal midface lift

The author performs endoscopic midface lift via the subperiosteal dissection level using 2 approaches: gingival buccal sulcus and temporal. He describes his technique in detail, emphasizing recent changes. ( Aesthetic Surg J 2002;22:477-480.)