Midface Lift Research Articles

The SOOF lift as an adjunct in rehabilitation of facial paralysis: help or hype?

Rehabilitation of the midface in chronic facial paralysis is one of the last frontiers in global facial reanimation. The suborbicularis oculi fat pad lift, or SOOF lift, also known as the midface lift, has been popularized in aesthetic surgery literature as a way to restore midface fullness with a youthful appearance while eliminating midface sag associated with aging. These techniques of midface aesthetic rejuvenation have recently been applied in cases of chronic facial paralysis. This article analyzes the role of the midface lift or SOOF lift in cases of facial reanimation and determines whether or not it is of benefit to patients affected by chronic facial paralysis.

Rejuvenation of the brow and midface

The upper face is often inadequately addressed when evaluating surgical rejuvenation for the aging face. Failure to diagnose and treat the upper face appropriately leads to facial disharmony. To successfully treat the aging upper face, the surgeon must have a knowledge of anatomy, brow aesthetics, the different surgical techniques with advantages and disadvantages of each, indications for surgery and patient selection, and potential complications. This article discusses all of these factors plus a detailed operative technique for endoscopic forehead midface lift.

Buccal Fat Pad Pedicle Flap for Midface Augmentation

Midface aging is characterized by soft-tissue ptosis with loss of cheek projection. Subperiosteal midface lifts may reposition the soft-tissue mounds and improve the tear trough, but may not fill the lateral cheeks in patients with significant jowls or poor bony support. Correction with alloplastic implants is helpful, but may not be accepted by many patients. During subperiosteal midface lifts, the author often excises Bichat's fat pad to decrease the jowl and to diminish face fullness. He has modified this approach and used a vascularized Bichat's fat flap to aid lateral cheek projection while still improving lower face fullness and the jowl. For the last 4 years, close to 150 patients undergoing subperiosteal midface lifts have had vascularized Bichat's fat pad flaps. The jowls were marked preoperatively. All patients had complete cheek undermining either through a buccal sulcus incision or through a crow's-foot incision, or through a muscle-sparing limited lower blepharoplasty incision. Bichat's fat pad is identified in its pocket medial to the masseter tendon. Mobilization of Bichat's fat pad is done by blunt dissection, preserving its thin fascial envelope. The "hernial saclike" pocket, excluding Stensen's duct and the buccal branches of the facial nerve, is identified and protected. Suspension is accomplished by fixation with 3-0 polydioxanone sutures either to the temporalis fascia (via the temporal incisions), to the arcus marginalis, or to the suborbicularis oculi fat pad. Fixation technique is dependent on where the fat pad is needed and the surgeon's preference. Fat pad repositioning is accomplished with a minor learning curve. The most common problems are tearing of the fat pad during fixation and temporary numbness of the long buccal nerve. Attention to leaving the capsule intact and gentle handling is essential to fixation. Nevertheless, in some patients with poor-quality fat pads, fixation is extremely difficult. Four-year results have been excellent. Further studies with magnetic resonance imaging of postoperative patients are necessary to assess longevity. Bichat's fat pad provides autologous vascularized tissue for midface fill. Placement may be lateral for cheek augmentation or medial for deep nasolabial folds. Jowl improvement also occurs with the removal of Bichat's fat pad from its pocket.

Modifications in endoscopic facelifts.

Since 1996, 72 patients (66 women and 6 men) have undergone endoscopic upper and midface rejuvenation. Sixteen of these patients had concomitant lower face rejuvenation at the same time. The patients were operated using a personal endoscopic technique, including biplanar endoscopic dissection (subgaleal and subcutaneous) at the forehead and temporal regions, excision of a galeal strip approximately 1 cm in thickness (to achieve a stable forehead lift), and a lower blepharoplasty incision for midface lifting and fixation of the malar fat pad. This approach helps to prevent midface widening-a concern of most surgeons. Regarding patient satisfaction, 51 patients had excellent results, 16 patients had good results, and 5 patients had an improved appearance of the mid and upper face. Complications included 11 incidences of temporary numbness in different regions of the upper and mid face, three incidences of temporary lower lid retraction (which did not require additional revision), three relapses of eyebrow elevation (which were reoperated), and unbalanced eyebrows in 2 patients (which were corrected during secondary revisional procedures).

Transmalar Subperiosteal Midface Lift: Technical Modifications, New Suggestions, and Limitations

“Surgical Strategies” focuses on refinements in aesthetic surgical techniques. Contributors are Aesthetic Society members or other recognized experts.

Midface Lift: Techniques for Correction of Facial Aging

Patients present for evaluation of facial aging with a variety of concerns and expectations. This article will describe our experience with two procedures, the lower lid blepharoplasty incision and the multiplane temporal approach. These approaches were designed by Hester and Byrd to provide access to the midface region most commonly addressed in the younger patient.

Subperiosteal brow and midface lifts.

Subperiosteal brow and midface lifts.

Transmalar Subperiosteal Midface Lift: Early Results With a Simplified Approach

A tear trough over the infraorbital rim; a depressed paranasal area; a ptotic, narrow nasolabial fold; and a ptotic oral commissure were inadequately corrected using my subSMAS facial rhytidectomy technique. A transmalar subperiosteal midface lift to improve these problem areas by elevating the periosteum, as well as the origins of certain mimetic muscles, is presented.

Facial rejuvenation: A combined conventional and endoscopic assisted lift

This article describes our personal approach for facial rejuvenation combining conventional and endoscopic procedures. For a forehead lift we use an endoscopic assisted technique. However, for the face and neck we still prefer the conventional lift. Good candidates for subperiosteal endoscopic midface lifts without skin resection are young or middle-age patients with midface ptosis and pronounced nasolabial/nasoyugal folds, without significant skin excess. Ptosis of the temporo-malar or facial area is also a good indication for subcutaneous endoscopic assisted lift. Aesthetic improvement of the forehead is evaluated with objective data of preoperative and postoperative measurements. We find this minimally invasive technique less traumatic and time consuming. It allows a greater range of possibilities for individual needs because it limits the incision and dissection to the required areas and has a higher level of acceptance by the patients. It is also a good complement to a conventional face lift.

Subperiosteal minimally invasive laser endoscopic rhytidectomy: the SMILE facelift.

Current concepts of total facial rejuvenation involve a comprehensive integrated approach to achieve a balanced youthful appearance. Recently introduced endoscopic-assisted techniques allow us to rejuvenate the face through small, remote incisions. Previously, we have considered only young patients with good skin turgor as candidates for minimally invasive procedures, but the advent of the resurfacing laser has allowed us to expand our indications for single stage minimal access rejuvenation. Full facial immediate laser resurfacing at the time of standard rhytidectomy has been avoided due to risk of flap necrosis. Subperiosteal minimally invasive endoscopic assisted techniques do not substantially interfere with facial blood supply. We can now perform endoscopic-assisted full facelifts combined with immediate laser resurfacing to reposition the tissues in a more youthful position and then tighten the skin envelope. Extended endoscopic-assisted subperiosteal forehead lift is performed through three to five scalp incisions; subperiosteal midface lift is performed through a crow's foot or intraoral incision. Cervicoplasty, if needed, is performed through a small submental incision. Full face laser resurfacing is done using a Coherent Ultrapulse laser. To date we have performed eleven subperiosteal minimally invasive laser endoscopic (SMILE) rhytidectomies. There has been no evidence of flap necrosis with this technique. Postoperative recovery has been no different from patients treated only by full face resurfacing, except perhaps for the slight increase in early facial edema. We believe the SMILE facelift is a viable alternative to standard techniques. The limitations of this procedure still need to be elucidated.

Subperiosteal brow and midface lifts.

The subperiosteal browlift and midface lift combination is a total mobilization of the composite full-thickness soft tissues from the bony skeleton with superior suspension. The object is to correct midfacial ptosis and the "tired" look of the lateral eyelids. It is done in conjunction with a browlift so that a composite correction of the upper and midface is achieved. When indicated, a modified lower cheeklift and the usual procedures for correcting neck deformities are utilized in combination. We believe the procedure is safe and the results reported are natural and long-lasting. This review of 130 cases also stresses technical aspects and the safety of the procedure.

Endoscopic-assisted forehead and midface lifts

“Surgical Strategies” focuses on refinements in aesthetic surgical techniques. Contributors are Aesthetic Society members or other recognized experts.