We describe a novel procedure for an anatomically-based face lift to correct vertical vectors in the ageing face. It has the advantage of surgical simplicity, minimal tissue removal and minimal risk. It provides an effective readjustment of cheek volume and correction of periorbital hollowness. Natural facial expression is preserved largely because there is no change in the position of the lateral canthus.
The cheek is mobilised subperiosteally through a blepharoplasty incision. A second dissection is made via a short temporal incision, to join the infraorbital dissection. A Hagedorn needle is then inserted through a point inferior to the lateral canthus and in line horizontally with the nasal ala. It is passed to the orbital incision, charged with a loop of suture material, and pulled down again to the cheek incision, from where it is pushed back to the orbit to suspend the cheek. The upper border of orbicularis oculi is fixed firmly to the temporalis aponeurosis at the level of the temporal incision. We now frequently use an Endotine Midface device for fixation. Of the first 150 patients, results were excellent or good in 145.
This represents a revival of the subperiosteal mask lift, and abandons the use of endoscopic techniques. In spite of its simplicity, the operation involves subperiosteal dissection as well as delicate eyelid surgery that necessitate plastic surgical skill.
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- The retaining ligaments of the cheek.Plast Reconstr Surg. 1989; 83: 11-16
- Lifting facial sous-periosté.Ann Chir Plast Esth. 1989; 34: 193-197
- The subperiosteal bicoronal approach to total facelifting: the DMAS – deep musculoaponeurotic system.Aesthetic Plast Surg. 1991; 15: 285-291
- The deep musculoaponeurotic system flap and extended open subperiosteal face lift combined with onlay cartilage grafts.Plast Reconstr Surg. 2000; 105: 1188-1195
- Cutaneous incision in facelift. Oblique cervicomalar SMAS flap and malar facelift. Technical notes.Ann Chir Plast Esthet. 1994; 39: 756-764
- The “R.A.R.E.” technique (reverse and repositioning effect): the renaissance of the aging face and neck.Aesthetic Plast Surg. 2004; 28: 127-142
- Endoscopic forehead lift. Evaluation and update.Clin Plast Surg. 1995; 22: 661-673
- Surgical anatomy of the mimic muscle system and the facial nerve: importance for reconstructive and aesthetic surgery.Plast Reconstr Surg. 1987; 80: 686-690
- The frontal branch of the facial nerve: the importance of its variations in face lifting.Plast Reconstr Surg. 1966; 38: 352-356
- Structural fat grafting: more than a permanent filler.Plast Reconstr Surg. 2006; 118: 108S-120S
- Endoscopic facial rejuvenation: endoforehead, the functional lift.Aesthetic Plast Surg. 1994; 18: 21-29
- Evolution of the technique of direct transblepharoplasty approach for the correction of lower lid and midfacial aging: maximizing results and minimizing complications in a 5-year experience.Plast Reconstr Surg. 2000; 105: 393-408
- Endoscopic deep periorbital lifting: study and results based on 50 consecutive cases.Aesthetic Plast Surg. 2000; 24: 292-298
- Anchor subperiosteal forehead lift: from open to endoscopic.Plast Reconstr Surg. 2001; 107: 872-873
- Full face rejuvenation in three dimensions: a “face-lifting” for the new millenium.Aesthetic Plast Surg. 2001; 25: 152-164
- Three-dimensional endoscopic midface enhancement: a personal quest for the ideal cheek rejuvenation.Plast Reconstr Surg. 2002; 109: 329-349
- Update in endoscopic forehead rejuvenation.Facial Plast Surg Clin North Am. 2002; 10: 37-51
- The subperiosteal lift.Aesthetic Plast Surg. 1993; 17: 151-155
Published online: June 14, 2007
Accepted: May 1, 2007
Received: November 16, 2006
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.