Thankyou for your question. The periosteum is a tough layer of fibrous tissue that sits on the surface of bone. when lifting the face a surgeon chooses a layer to dissect under that is safe and offers access to the region being lifted. Unlike the overlying soft tissues of the face the periosteum does not sag with age although the underlying bone may shrink a bit. A subperiosteal lift is therefore using this layer for access and as a tough layer to hold sutures when the overlying tissues are lifted. In some areas of the face this dissection plane is used routinely, an example being the forehead where most brow lifts are done using the subperiosteal plane. It is also a useful dissection plane if the facial skeleton is being modified with , for example, cheek or chin implants. It is rarely used for facelifting these days as more accurate and tailored results can be obtained by dissecting a little closer to the surface, usually with less swelling and quicker recovery. The problem with subperiosteal lifting in the face is that the very tough nature of periosteum means that the whole block of tissue moves as a unit in one direction only unless numerous releasing incisions are made. in the mid face the tissues age in a radial pattern around the orbit and rejuvenation usually requires a concentric movement of volume back towards the orbital rim. Many of the subperiosteal mid face lifts create a swept look with the cheek fullness too high and lateral often with the squinting part of the orbicularis muscle lifted into the eyelid . this creates an unnatural look particularly when the person blinks as it can look as though they are blinking with their cheeks (squinting each time they blink).
Subperiosteal mid-face lifts elevate the facial tissue by lifting the periosteum off the bone of the cheek and lifting all of the tissue as one unit to a higher level. It is a reasonable option for men or women with cheeks that have sagged, but they don't have a lot of jowling or loose skin in the neck.
Potential problems with subperiosteal lifts include prolonged swellling, recurrent sagging if the overlying tissues aren't firm enough to be pulled up with the periosteum, nerve injury, and pulling downwards on the lower lids.
Great question. I first published my work on the subperiosteal mid face lift in 1998. As I said at one presentation, I have modified the majority of things I have done during my 25 years of experience, but the subperiosteal mid face is something I have changed very little, and it is one of my favorite procedures. I personally don't like the idea of doing it through the lower eyelids. The integrity of the lower eyelids should be preserved at all costs in my opinion, and certainly extra skin should not be taken out through the lower eyelids. The intraoral and temporal incisions are the most direct and natural in my opinion - doesn't leave visible scars. The deep plane facelift is probably done a lot more frequently than the subperiosteal. It does tighten the muscular support layer in addition to the skin; but, again in my opinion doesn't tighten everything in the mid face like the subperiosteal does. The subperiosteal lift provides incredible support of the lower eyelid and rejuvenation of the cheek pads. Definitely consider this a biased answer based on my love of the subperiosteal mid face lift, which can be done sometimes as an isolated procedure, but more commonly as part of a full facelift.
Hi, I have performed many facelifts over the past 30 years. Deep plane facelifts have exytensive tissue dissection below the SMAS muscle layer while subperiosteal facelifts go even deeper and are more invasive, IMHO, with incisions inside the mouth and within the temple these lifst pull in such a manner that the eyebrows and corners of the mouth are elevated into an un-natural upturned position.
If you have "jowls" this is sagging
facial tissues and an indication for some form of a facelift, not Cheek
Augmentation. I have performed many Cheek Augmentations over the past 30
years and the notion that Cheek Implants or dermal fillers alone to the cheeks will
lift tissues is an urban myth. Filler to the cheeks or cheek implants
will shape the cheeks but will not lift up the jowls. The underlying SMAS
layer, of the face, must be dissected, lifted, trimmed and re-sutured.
The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally
invasive, short incision facelift that has all the benefits of more invasive
facelifts (traditional, mid-face, deep plane and subperiosteal facelifts) but with these
•very small incisions
•minimal tissue dissection = less bruising and
swelling = rapid recovery
•can be performed in 90 minutes or less, with or
•no incisions within the hair = no hair loss
•excess fat can be removed
•excess skin removed
•cheeks, chin and jaw line can be augmented with
dermal fillers (I prefer Restylane Lyft) or facial implants
•most patients fly back home to parts all over
the world in as little as 3 days post-op
Hope this helps.
A subperiosteal facelift is a type of facelift procedure that lifts the mid face tissues by performing a dissection on top of the bone of the mid face. This procedure is usually performed through an intra-oral approach ( through the mouth) and through incisions in the lower lids ( eyelid lift / blepharoplasty incisions). It also can be done trough an endoscopic approach through incisions in the hair bearing scalp.
Since the "lifting" capacity of a subperiosteal facelift is not as powerful as other techniques that involve the traditional facelift incisions ( scars in front of the ears), this type of facelift is usually recommended to young patients ( 40s) who have minimal skin laxity but descend of the mid face soft tissues, and don't want /it is not recommended traditional facelift scars.
Thank you for asking about your subperiosteal mid-face lift.
(Sub-periosteal means under the tissue over the bone.)
- Excellent question with a complicated answer.
- The mid-face is usually treated first with fillers
- If fillers don't work or become too expensive to keep repeating them, surgery is done.
- This is either a mid-face lift or a mid-face implant - which is permanent 'filler' to support the mid-face
- Implants makes sense because they replace bone and soft tissue volume that is lost with age.
- .Implants are put in via the mouth, so leave no visible scar and go under the periosteum
- The endoscopic sub-periosteal face lift was popular but less done now as results may not last.
- Mid-face lifts through the lower lid can be under or over the peri-osteum.
- The risk is ectropion - swelling and gravity pulling the eyelid down, instead of the mid-face up.
- The preference today is over the periosteum for a more natural look.
- The lift raises the cheek but adds no volume.
Always see a Board
Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.
Thanks for your question. For patients with deep nasolabial folds, loss of cheekbone contour with aging, and "secondary" bags, the mid-facial lift (not the same as a "facelift") is an excellent procedure, and it can be performed in all the ways you have mentioned. I prefer to lift the soft tissues of the midface through lower eyelid incisions, and invariably perform lower blepharoplasties simultaneously, as the lower lids usually need fat bulges modified and "tear troughs" filled (and often the lids "tightened" with what is termed a "canthoplasty" procedure). See a board-certified Plastic Surgeon to discuss the options for your mid-face rejuvenation. Best of luck in your decision.
Thank you for the great question. A subperisoteal midface lift, or as some would describe in marketing terms as an "endoscopic facelift", is an approach which calls for elevation of the tough periosteum from the maxilla in an attempt to raise the cheeks. The problems with this approach are 1) when performed conservatively, much of the perceived result departs when the swelling is gone, 2) when performed aggressively leads to a very stylistic or "done" look, 3) the aging of the midface is not well addressed by lifting and repositioning the periosteum, and 4) this approach does nothing for the aging neck. This approach can work well in carefully selected patients, but is by no means an ubiquitous approach to facial rejuvenation.
Subperiosteal means the tissue is elevated at the level of the bone. Deep plane means it is done above the bone but below the SMAS. Swelling is greater and lasts longer the deeper you go.
The periosteum is the thin layer of facia that covers bone, in this case the cheek bone (zygoma). A subperiostel lift is below the periosteum and when this layer is lifted so is all of the superficial soft tissue.
This is a more invasive procedure than most of the newer technique and results in prolonged and extensive swelling. I no longer use this technique in my practice for these reasons.