Would a subperiosteal or preperiosteal mid facelift be best for festoons? (photos)

Question

I have malar edema/malar bags and mild midface aging. Most surgeons I've seen offer a subperiosteal mid-facelift. One surgeon has offered a preperiosteal mid-facelift along with tightening the obicularis oculi muscle and closing the anterior wall of the malar edema. I can't find any scientific studies that suggest a preperiosteal MFL for malar bags. Would this procedure be as effective as a subperiosteal MFL?

Ronald J. Edelson, MD · Answer

I’ve never been impressed with the midface lift.  I would do a standard facelift and your lower lids. Lower lid surgery would remove the excess fat and the skin can be tightened as well.

Lucian Ion, FRCS · Answer

Thank you for your question and photo

In general, the pre-periosteal mid-face lift is associated with lower level of facial swelling and faster resolution of the swelling compared with the sub-periosteal lift.

In view of the malar oedema there is a theoretical benefit for the super-periosteal or pre-periosteal approach, but as you have highlighted, there is no structured study to compare them .

The lift effect provided by the two approaches is reported as similar.

Stephen Prendiville, MD · Answer

Festoons are a difficult problem to treat, explaining why there are multiple approaches to address them.  I have seen success with an extended lower lid subiliary blepharoplasty and SOOF lift. This is a pre-periosteal approach.  My rational: the periosteum is a very deep, thick, inelastic layer while festoons are a more superficial soft tissue finding between eyelid and cheek.  This is a scenario where you choose the Surgeon and his/her results/experience/judgment over the specific approach.

Ajaya Kashyap, MD · Answer

Thank you for your query. The sub-periosteal face-lift and pre-peristeal mid face-Lift, lift the mid face structures in slightly different planes and have somewhat different results. In mild mid face laxity, pre-perosteal mid face lift with orbicularis tightening works well and has fewer complications. Where more pronounced lift is required a sub-periosteal mid facelift can give better results, when done well. The two factors that are important are how much laxity you have and the experience of the surgeon with the techniques. Please discuss the experience of your surgeons with both techniques and why they would choose one over the other. All the best!

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment we need a complete set of proper facial pictures. I’m not convinced you have festoons. There may be some malar edema.
Look for plastic surgeons who can show you before and after pictures of previous patients who have similar facial characteristics to your own, who have quality results
Midface, volume restoration could give impressive outcomes. This can be done with a number of different procedures. A mid facelift is one of them.
The procedure can still leave people swollen for quite a while after surgery.
Best,
Mats Hagstrom MD

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