J Korean Soc Plast Reconstr Surg.
1999 Mar;26(2):204-209.
Midface Lift Through Subciliary Incision
Abstract
- With aging, several progressive changes occur on the midface including descent of attenuated lower eyelid skin which creates a skeleton-like appearance with infraorbital hollowness, and descent of the malar fat pad with exaggeration of the nasolabial fold. Most of the procedures for midfacial rejuvenation require extensive peripheral-to-central dissection in the subcutaneous, sub-SMAS or subperiosteal plane. The author's procedure entails direct access to the midface through a subciliary incision, elevation of the orbicularis oculi muscle and ptotic malar soft tissue. It has been performed through subcutaneous dissection on 67 patient and subperiosteal dissection on 4 patients. Subcutaneous dissection on the midface was made laterally to the zygomaticus maior, medially to the levator labii superioris under the oricularis muscle and inferiorly beyond the nasolabial fold. The range of subperiosteal dissection was similar to subcutaneous dissection, except on the dissection plane. Suspension sutures made at the malar retaining ligament and infero-lateral portion of the orbicularis oculi were fixed to periosteum of the lateral canthal area. In some patients, this procedure was combined with forehead lift(4), temporal lift(2), upper blepharoplasty(28), cervicoplasty(2), and lateral canthoplasty(12). In 23 patients who had a particularly prominent tear trough, a fat sliding technique was combined. The author has followed up 62 patients from a minimum 2 months to a maximum 27 months. Complications included urdercorrection(3), longstanding malar fullness(2), ectropion(1), transient numbness(2), and cheek dimpling(1). In conclusion, this centrofacial can be applied to patients who have limited ptosis of the midface with mild nasolabial fold.
