Subperiosteal Lift Research Articles

Le MASK lift

The MASK lift or subperiosteal lift of the upper and middle thirds of the face is a procedure that can be performed alone for aesthetic purposes, but can also be combined with reconstructive surgery of this region to improve the result. This procedure will enable the overall result to be enhanced in the management of complex pathologies. The aim of this article is to present the MASK lift surgical technique in detail, to explain its indications and to show that this surgical technique still has a place in our practice.

Current Practices and Trends in Midface Rejuvenation.

Cosmetic approaches to midface aging are complex and vary in their treatment methodology. The nature of cosmetic surgery limits clinical trial data, forcing surgeons to rely on small studies and professional preferences when choosing an approach. Our study aimed to quantitatively assess national trends in midface rejuvenation practices. We conducted a cross-sectional study consisting of a survey administered through the American Academy of Facial Plastic and Reconstructive Surgery and the American Society of Plastic Surgeons listservs. To evaluate trends, techniques were grouped into 2 categories: minimally invasive (injectable fillers, fat transfer, fat repositioning) or invasive (deep plane facelift, subperiosteal lift, malar/cheek alloplastic implant, bone grafting/bone advancement). Two hundred thirty-two survey responses were received. Of the total respondents, 46.52% were certified by the American Board of Facial Plastic and Reconstructive Surgery, and 48.26% were certified by the American Board of Plastic Surgery. Minimally invasive techniques were far more preferred (66.67%) over invasive (33.33%) techniques, with injectable fillers as the most common technique (34.88%), followed by fat transfer (20.93%). Deep plane facelift was preferred over subperiosteal lift (18.60% vs 7.91%, respectively). Surgeons board certified by the American Board of Facial Plastic and Reconstructive Surgery were more inclined to perform invasive techniques over those board certified by the American Board of Plastic Surgery (P = 0.0427). This study quantitatively assessed national trends in cosmetic approaches to midface aging. Our data suggest that trends among surgeons across the United States have shifted toward favoring minimally invasive techniques over more invasive approaches.

Reduction Malarplasty With Subperiosteal Lift Via a Single Limited Temporal Incision.

Different from Western culture, prominent zygoma and rectangular facial contour are deemed as unaesthetic and masculine in Asians. To achieve an ideal oval facial shape, reduction malarplasty is often performed. Twenty-two eligible patients who underwent reduction malarplasty between November 2008 and December 2018 were reviewed. The reduction malarplasty involved repositioning of the osteotomized zygomatic arch and subperiosteal lift via a limited temporal incision. Photographs were collected both preoperatively and postoperatively. Complications and postoperative outcomes were evaluated. Twenty-two patients underwent reduction malarplasty with subperiosteal lift between November 2008 and December 2018. Their mean age was 35 ± 2.30 years. Prominent zygoma and facial contour were significantly improved after surgery. Patients demonstrated satisfaction with outcome (73.77 ± 6.83) and with facial appearance (75.00 ± 5.60). No cheek drooping and major complications were observed during the long-term follow-up. Prominent zygoma treated with reduction malarplasty with subperiosteal lift via limited temporal incision has a stable and long-lasting effect. This approach can be regarded as a true alternative for facial contour reshaping.

The Facelift in South American Patients.

South America is a vast territory; its people were made from all parts of the world. The miscegenation made a unique population comprised of Indian, Asian, Caucasian, African, Mestizo, Mulatto, and Zambo. The South American patients tend to have a wider face with a skin-soft tissue envelope (S-STE) that is thicker, heavier, and has less elasticity than the Caucasian patient. Upper eyelids may hood easily. In the same way, malar eminences and round face look are more prominent. The chin can be a little retracted. With aging, the S-STE tends to sag more, making nasolabial folds and jowl area more prominent, and redundant neck skin will appear loose and heavy. Facelift is popular in South American patients. They have peculiar characteristics like heavy dark sebaceous skin which lead to peculiarities in face lifting. It is usually a procedure designed to rejuvenate all thirds of the face. In the forehead, skin excision in temporal incisions is usually necessary. Midface subperiosteal lift is a possibility for heavy skin patients who need great improvement in the center of the face. The neck lift is almost indispensable to the rejuvenation of the lower third. Extended superficial muscular aponeurotic system or deep plane dissection is commonly performed so the soft tissues of the midface, the jowls, and the neck can be lifted to reestablish their youthful relationship with the underlying skeleton.

Understanding Midfacial Rejuvenation in the 21st Century

Facial rejuvenation has largely focused on surgical procedures of the lower and upper one thirds of the face. Over the past 15 years, research focus on the midface has given aesthetic facial surgeons more tools to improve the signs of aging. The term midface has been used with various definitions, but includes the lower eyelid subunit beginning at the inferior border of the tarsal plate and cheek, down to the nasolabial fold. Many surgical approaches to the midface have been described including skin tightening with direct excision, skin-muscle flaps, fat repositioning, and, our preferred method of endoscopic browlift approach, subperiosteal lifting. We will describe the anatomy and aging of the midface, review surgical and adjunctive techniques, describe our method of the subperiosteal midface-lift including its limitations and risks, and discuss current challenges.

A New Assisted Fixation Technique to Prevent Zygoma Displacement in Malar Reduction

Reduction malarplasty via an intraoral approach for correction of a prominent malar complex is quite popular in the Orient. However, one point of fixation in the anterior zygoma body area, the most widely used method, sometimes is insufficient and likely to result in malunion and cheek drooping. We designed a new assisted fixation technique to strengthen the effect of fixation. Two parallel oblique vertical ostectomies were performed on the zygomatic body with a groove left in the inner osteotomy line. The zygomatic arch root was cut obliquely through a small sideburn incision just in front of articular tubercle, medial to lateral and anterior to posterior. The freed malar complex was medially and superiorly repositioned with the zygomatic body wedged in the groove, followed by fixation with one miniplate or wire. Finally, the periosteum in the zygomatic area was pulled and sutured to the deep temporal fascia. Most patients were satisfied with their results. No inferiorly displaced malunion occurred in the zygomatic body. There were no serious complications such as nonunion or permanent facial nerve injury. Minor complications, including palpable step-off, mild asymmetry, hematoma, and mild cheek drooping, occurred in some cases. Our assisted fixation method, combined with subperiosteal lifting, can provide ideal effects and sufficient fixation in malar reduction to prevent many complications such as malunion and cheek drooping. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Canadian Society for Aesthetic Plastic Surgery 39th Annual Meeting

Understanding the anatomy of the superficial fascia and its relation to the deep fascia, retaining ligaments and facial nerve is critical to safe sub-SMAS surgery. Facial surgery is an exercise in understanding three-dimensional nuances of complex face and neck anatomy. While the topographic anatomy of the face and neck is straightforward, the anatomy superficial-to-deep is complex and less easily mastered. With clear understanding of the complex three-dimensional anatomy, grasp of facial proportions and understanding the means of biomechanically addressing facial aging, surgery becomes easier. In the first part of this presentation, the platysma-SMAS complex spatial relations will be described and the relationship of ligaments, facial nerve branches and muscles of facial expression will be outlined. These structures relate to one another consistently in three-dimensional fashion and once these relationships are mastered facelift operations become easier. Three prototype subSMAS procedures will be described and outlined: Extended (separate skin-SMAS) SMAS flap, deep-plane facelift and subperiosteal lift, illumination of benefits and the drawbacks and similarities of the three procedures. Surgical correction does not necessarily require extended release at the sub-SMAS level. SMASplication, lateral SMASectomy and minimal access cranial suspension procedures have their place in facial rejuvenation. The concepts behind the efficacy of these operations will be outlined. Finally, the neck will receive special attention as this is often the most difficult part of the facelift. The author’s preference for medial platysmaplasty, superficial deep-fat removal and muscle modification will be described and the biomechanical benefits elucidated. Other authors’ preferences regarding the posterior approach will also be described.

The Canadian Society for Aesthetic Plastic Surgery 39th Annual Meeting

Understanding the anatomy of the superficial fascia and its relation to the deep fascia, retaining ligaments and facial nerve is critical to safe sub-SMAS surgery. Facial surgery is an exercise in understanding three-dimensional nuances of complex face and neck anatomy. While the topographic anatomy of the face and neck is straightforward, the anatomy superficial-to-deep is complex and less easily mastered. With clear understanding of the complex three-dimensional anatomy, grasp of facial proportions and understanding the means of biomechanically addressing facial aging, surgery becomes easier. In the first part of this presentation, the platysma-SMAS complex spatial relations will be described and the relationship of ligaments, facial nerve branches and muscles of facial expression will be outlined. These structures relate to one another consistently in three-dimensional fashion and once these relationships are mastered facelift operations become easier. Three prototype subSMAS procedures will be described and outlined: Extended (separate skin-SMAS) SMAS flap, deep-plane facelift and subperiosteal lift, illumination of benefits and the drawbacks and similarities of the three procedures. Surgical correction does not necessarily require extended release at the sub-SMAS level. SMASplication, lateral SMASectomy and minimal access cranial suspension procedures have their place in facial rejuvenation. The concepts behind the efficacy of these operations will be outlined. Finally, the neck will receive special attention as this is often the most difficult part of the facelift. The author’s preference for medial platysmaplasty, superficial deep-fat removal and muscle modification will be described and the biomechanical benefits elucidated. Other authors’ preferences regarding the posterior approach will also be described.

Existe-t-il un traitement approprié aux poches prémalaires ?

The treatment of malar bags is known to be particularly difficult; although it is not the most frequent palpebral anomaly justifying a surgical recourse, this problem cannot be ignored. It is important to distinguish their minor forms and to be able to analyze them in order to propose the best to our patients. We review the literature concerning this subject. The various surgical techniques are discussed and we present five of our cases. Even taking into account its various evolutions, the standard lower eyelid blepharoplasty can correct neither the ptosis nor the excess of orbicularis oculi muscle, which appear to be the main components of the malar bag. Publications, precisely mentioning malar bags or festoons, analyzing their physiopathology or their treatments, are few. We discuss the current data of the literature and on the results obtained in our experiment, and the surgical techniques suggested for their treatment. All the techniques suggested for the malar bags remain local or regional approaches. Results obtained with those techniques do not seem effective to us: although it has not been specifically proposed for the treatment of malar bags, the midface sub-periosteal lift, combining a skin flap lower eyelid dissection and a subperiosteal malar dissection, seems to be able to correct the lowest part of the orbicularis oculi muscle due to its concentric action and its major vertical vector of traction. This study underlines the importance of clinical analysis of the malar bags to appreciate the contribution of each element. So the surgeon will be able to choose the most adapted treatment, which is most often a midface sub-periosteal lift associated with a blepharoplasty.

The Sling Lift: An Ancillary Procedure for Malar Rejuvenation

The malar region has been a crucial target in many facial rejuvenation techniques because the beauty and youthful contour of a convex midface and a smooth eyelid-cheek sulcus are key features of a pleasing face-lift result. The full midface subperiosteal lift has helped to address these issues. However, the desire of patients currently for a rapid recovery and return to work with a natural-looking result has influenced procedural selection. Another concern is for safer procedures with reduced potential risk. Progressively fewer invasive techniques, such as the minimal access cranial suspension (MACS) lift, have been a response to these core concerns. After 3 years of performing the conventional three purse-string suture MACS lift, the author developed a practical procedural modification. For a total of 17 patients, the author combined limited regional subperiosteal lift and periosteal fixation with a simple sling approach to the more fully released malar tissue mass to make a single-point suspension just above the lateral orbital rim. The percutaneous sling lift appears to offer a degree and naturalness of rejuvenation of the malar region similar to those of the MACS lift and the full subperiosteal midface lift, but with fewer suspension points and less undermining. Also, the author observed less ecchymosis and edema than with the full midface subperiosteal lift, as would be expected. In all 17 cases, the need for the second and third purse-string sutures was eliminated. The early results for the percutaneous sling lift indicate that it offers promising results, rapid recovery, and reduced risk of serious complications.

‘Optimum Mobility’ Facelift. Part 1 – the Theory

Traditional rhytidectomy techniques, such as the cutaneous lift, the superficial musculoaponeurotic system lift, the deep plane lift and the subperiosteal lift, are mostly differentiated by their different planes of dissection. As well, many of these techniques consider the complete mobilization of tissues a prerequisite for obtaining a satisfactory result.However, is it true that the result of a rhytidectomy is linked to the choice of the dissection plane? Also, is it true that the adequacy of the surgical mobilization of tissues is vital to the outcome? The present paper discusses the above questions and introduces a factor that is believed to be crucial to the planning and success of a rhytidectomy: facial tissue mobility. The analysis of this mobility is presented and leads to the development of three theories: 'intrinsic mobility', 'surgically induced mobility' and 'optimum mobility points'. These theories form the foundation of a rhytidectomy technique termed 'optimum mobility' facelift.

Aesthetic surgery – pertinent papers 2002–2003: A personal view

Aesthetic surgery – pertinent papers 2002–2003: A personal view

Full face endolift: 10 years evolution

The author describes his personal procedure for endolift centred on the midface. Techniques are described for superior blepharoplasty, dissection of the midface and subperiosteal forehead lifting. The suspensions are multiplied and matched to each case selection. The neck is treated according to Giampapa's technique. The results are stable over a five‐year follow‐up. This technique has been significantly simplified; recovery is rapid and the risk of injuring of the branches of the facial nerve is dramatically reduced.

Surgery of the Superficial Musculoaponeurotic System: Principles of Release, Vectors, and Fixation

The SMAS was described more than 25 years ago, yet its full potential in face-lift surgery has become appreciated only more recently. A reappraisal of the various aspects of SMAS surgery is now appropriate. These include aspects of its release from the deep fascia, the several considerations underlying the vectors of flap redistribution, and the rationale underlying the methods of flap fixation. These are unique, compared with the traditional considerations in subcutaneous face lifts and en bloc subperiosteal lifts.

Direct needle fixation in endoscopic facial rejuvenation

Background: Several authors have described the application of video endoscopy to facial rejuvenation to minimize incisions. Methods of fixation used in this technique include miniplates, tunnels in the outer tissues, and tissue glues. Objective: In this study, we examined the efficacy of endoscopic facial rejuvenation with direct transcutaneous needle fixation. Methods: Detailed preoperative markings were placed to outline important anatomical structures for the dissection. Dissection was performed through use of endoscopic visualization. Direct needle fixation was performed through a temporal incision. Results: In a series of 50 patients, we found that subperiosteal lifting with direct needle fixation allows more precise repositioning of the inferior, periorbital, and frontal regions. In 30 patients undergoing additional treatment for the midface, this technique eliminated the need for midface intraoral and/or infracilliary incisions. Conclusions: Endoscopic facial rejuvenation through use of direct needle fixation provides safe and aesthetically pleasing results with a high level of patient satisfaction at 24 months' postoperative follow-up.

Evolution from endoscopic to miniinvasive facelift: a logical progression?

Endoscopy has revolutionized the field of aesthetic surgery, permitting the advent of cosmetic surgery via minimal incisions. The procedures are modifications of subperiosteal lifting techniques which grew out of craniofacial surgery. Nonetheless, the cumbersome instrumentation and changes in operator technique have led to the development of a subperiosteal facelift through minimal incisions without the aid of endoscopy. This miniinvasive approach has yielded equivalent results to our endoscopic rhytidectomies in appropriate patients, with reduced morbidity, edema, and operating time. Further, it permits the avoidance of preauricular scars in the majority (84%) of patients; 63 cases are presented, with a follow-up of up to 4 years.

Fourth-generation subperiosteal approach to the midface: The tridimensional functional cheek lift

The fourth-generation subperiosteal cheek lift preserves full function and integrity of the orbicularis oculi muscle It minimizes the potential for eyelid complications. The addition of the IMP and the BFP suspension provides a truly three-dimensional cheek lift. Repositioning of the aging eyelid, cheek, paracommissural tissue, and jowl gives a pleasing aesthetic result (Figures 3 and 4). See the Table for additional advantages, as well as the disadvantages of the fourth-generation approach.

Subperiosteal facelifting: Complications and the dissatisfied patient

As endoscopic subperiosteal lifting of the upper face is explored, it may significantly limit the indications for the open approach. However, this report is based on our combined large experience and long follow-up in open bicoronal subperiosteal lifting. The combined experience of four surgeons in four countries with an open subperiosteal approach to lifting of the upper face in 545 patients is described. The complications of the procedure, both common and rare, and techniques to avoid untoward effects are discussed. Reasons for patient dissatisfaction are addressed. Based on their evaluation of results and complications of the surgery over a 6-year period (1986-1992), we conclude that subperiosteal lifting is an effective, reliable, reproducible, and safe operation.

A Comparison of Flap Vascular Anatomy in Three Rhytidectomy Techniques

The purpose of this study was to examine differences in blood supply to facial flaps created by three rhyditectomy techniques. The techniques chosen for comparison included a two-layer technique, consisting of separate subcutaneous and extended submuscular aponeurotic system (SMAS) dissections, the Composite dissections as described by Hamra, and a subperiosteal dissection. Six cadavers were injected with lead oxide before dissection, and eight were injected after dissection. After allowing the lead oxide to set, the soft tissues were removed from the face. Vascular patterns of the face were interpreted from x-rays taken of the specimens. Results of the injections performed before dissection confirmed contributions of previously described arteries, including the transverse facial, facial, infra-orbital and terminal branches of the ophthalmic. In addition, there are numerous branches that connect these vessels to each other. The most consistent of these include the masseteric, jugal, submental, labial, angular and nasal arteries. The patterns of communications between these vessels allow for the visualization of three vertically oriented vascular zones, each connected to the next by choke zones where anastomoses occur. Dissections performed before injection reveal increased filling of the vessels through more of the flap on the Composite side when compared with the two-layered dissection, absence of vessels in the SMAS, and filling across all three zones on the subperiosteal side. We conclude that there are vascular regions in the face connected by anastomotic choke zones. Separate subcutaneous and sub-SMAS dissections interrupt the vascular connection between zones. Arterial continuity is better-maintained in the Composite lift and is literally undisturbed in the subperiosteal lift.(ABSTRACT TRUNCATED AT 250 WORDS)

Facelifting : an initial eight year experience

A retrospective analysis of facelifting experience during the author's initial 8 years of consultant practice is presented. 137 procedures are reviewed and the surgical technique described. 70 % were SMAS-platysma lifts, 24% skin only lifts and 6 % subperiosteal (mask) lifts. Particular attention was paid to complications, most common of which was haematoma requiring surgical evacuation in 3.6 % of patients.