Not all midfacelifts are created equal

Hi Genie,

If only we had a surgery that does what can be accomplished by pushing the face around with one's hands.

Many mid-face lifts have an incorrect vector of pull. This includes the so-called subperiosteal mid-face lift. The most common vector of pull is superior and toward the temple. Surgeons like this because the dissection plane is well understood and there is good tissue to sew to in the temple. However there are two problems with this approach. First, the malar fat pad falls vertically from the lower eyelid and not in the direction of pull these surgeries create so the effect is, well, surgical.

Second, the surgical dissection can damage the fat in the temple and at the outer edge of the orbit. This causes a condition I call "plateau midface." The loss of tissue volume skeletonizes the top of the cheek bone. This is a bad thing because the small cushion of fat aroung the outer edge of the eye socket helps to keep conversational gaze on your eyes. When these tissues are damaged, the gaze can fall off the eyes and you end up felling like people you are speaking to are not paying attention.

The answer is to fill the under eye hollow with fillers or to perform a vertical midface lift over an orbital rim implant.

There are many types of cheeklift. Technically any cheeklift is a midface procedure because it deals with the tissues below the eyes into the cheek area. Subperiosteal is one method of cheeklift. Largely, the subperiosteal cheeklift performed through a lower eyelid incision is falling out of favor because of the chance of pulling down of the lower eyelid, or ectropion, even in highly skilled hands.

In response to the problems that were occurring with the subperiosteal subciliary cheeklift, I invented and published the superficial cheeklift in 1999 in the Journal Plastic and Reconstructive Surgery.

We now have a two new versions, the USIC and the LUSIC, cheeklifts with ultrashort incisions that either use LiveFill (when hollowness is present) or not (USIC), depending on the clinical situation.

Cheeklifts are among the most difficult procedures to perform, so it is my opinion that surgeons should have a special interest in this field before regularly undertaking such cases.

For a complete discussion, you may wish to read our book chapter in the textbook Mathes, posted on our website.

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The subperiosteal lift is one technique for doing a midface or cheek lift. There are multiple alternatives; the approach selected should be individualized to meet the needs of each individual patient.  

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