This operations as originally described was a subperiosteal midfacelift. A small incision is made in the upper lip sulcus and the maxillas is exposed subperiosteally up to the zygoma. Another incision is made behind the hairline in the temple and endoscopic dissection is done on the deep temporal fascia down to the medial zygomatic arch. The exposure is joined between the upper and lower areas and sufficient dissection is done so that the midface tissues can be elevated with a suture from the lower midface deep tissue up to the deep temporal fascia. This suture is tied under tension. Care is taken to try to go around the two sensory serves that come out of the zygoma and the deep temporal fascia. If care is taken not to go too lateral on the zygoma, it would be rare to injure the temporal branch of the facial nerve.
However, traction on the infra-orbital nerve which is sensory to the upper lip is inevitable, and if this is excessive permanent numbness or discomfort can occur. Since the result depends on tension to lift the midface, there exists an unacceptableand unpredictable risk of problems with traction on the infraorbital nerve, in my opinion. Unless wide dissection is done to release the tissues from the periosteum, this technique does not give adequate lift, and with wide dissection, the nerve is subject to traction. For this reason I do not recommend this technique.
Modifications of this technique exist, such as supraperiosteal and trans lower lid operations that are not subperiosteal and these may protect the infraorbital nerve better.
Nowadays, it makes more sense to do a less invasive procedure for the lower face and neck and add fat grafts to support the infraorbital cheek area.
In our practice, we do not perform the mid face lift, rather we augment a flat cheek profile with cheek implants. When patient's need a face lift to lift the jowls and tight in the neck, then we perform a comprehensive lower face and neck lift. For many examples of both cheek implants and facelifts, please see the link and the video below
I really don't think this is a particularly good procedure regardless you is doing it. The operation will pass through the plane of the facial nerve and subjects it to damage. I would get several other opinions about operative strategy before signing on to this.
The risks include, but are not limited to, bleeding, infection, anesthesia, permanent scars, injury to the infra-orbital nerve that supplies sensation to the middle third of face or the facial nerve branches that supply motor function to the facial muscles, asymmetry of the face, hair loss along the scalp incisions and recurrent sagging or laxity of the face requiring further intervention.
To me, the midface lift done through the temporal and oral approach doesn't give much improvement, so I don't perform it. Although the risk are low, the results just aren't that great. The biggest risk of the procedure is injury to a nerve. I prefer to stick to simpler techniques that gave a good track record.
I have done many of these procedure and find them very powerful in making the face more youthful. As with any procedure you need to have the correct patient with the proper indications. I have found complication ( in my personal experience) to no different from a facelift. Find a plastic surgeon who does a lot of these, ask lots of questions, take lot of notes and look at a lots of photos.
Stephen M. Davis, Md, FACS
Green Hill Plastic surgery
Midface lifts are just as complicated as any other face procedure and has similar risks as well as its own risks and complications. Typically, an endoscopic facelift is performed through the temple and the dissection is deep just above the bone. This dissection can be done without visualization from below through the mouth because a rod telescope is used to see everything. Any dissection through the mouth risks contamination of the wound with bacteria from the mouth. Facial nerve injury and decreased ability to move your upper lip are rare unless the dissection is done improperly.
Common complications from mid face lifting include infection but by far the most common is inappropriate use of midface lifting in patients that don't need this. See a very experienced surgeon who does midface lifting both through the temple and mouth and more importantly to determine if you need the surgery.
All of the complications that can occur with facial surgery can occur with the described procedure and those do include both sensory and motor nerve injuries though rare
It is the best procedure to address the face. It is a very safe procedure with a very, very low risk of nerve injury.
Please make sure the individual is a plastic surgeon who has experience, knowledge, confidence, artistry.
I never do intraoral incisions, stopped using cameras many years ago. incision area canthal and temporal.
must consider surgery to address brows, eyelids, metum, face, neck, lipoplasty, etc.
Remerber each surgery addresses a specific area of the face and each area needs a specific surgery.