Subperiosteal midface lift: why are surgeons still doing this?

Question

From what I've read, the subperiosteal mid face lift is controversial enough on its own. It is risky in terms of nerve damage, is renowned to cause mid face swelling and as a stand alone procedure, it can result in an hourglass type deformity where you look like the Scream. Is this true and why are surgeons still doing this?

Gregory S. Keller, MD, FACS · Answer

When performed in experienced hands, the subperiosteal midface lift is the only procedure that safely restores the mid face in a “natural” manner.  Newer technology (endotine and goretex loops) allow a less invasive endoscopic procedure that avoids areas that can cause nerve injury ( the lateral third of the zygoma). With these limited endoscopic procedures, swelling is comparable to fat injections, which can cause more bruising, absorb irregularly, and cause lumps.   There is certainly a place for implants and injections, but the subperiosteal midface lift produces a natural result that removes years in an in apparent natural fashion.

Ozge Ergun, MD · Answer

Thanks for the question. As you say, it is a risky process, but the risk is reduced by the measures taken and the long year experience. For this reason, surgeons continue to perform this operation. I wish you all the best.

Stephen Prendiville, MD · Answer

You ask a question that many of us ask.  However, although I cannot speak to the preferences of an individual Surgeon, I can speak to the logic of facial rejuvenation. A subperiosteal approach is a trauma approach, utilized by most of us in training for mid-facial trauma, etc.  Since the midfacial periosteum (lining of the bone) does not stretch or descend with aging, rather wide undermining is required to lift the midface.  Since the midface can be elevated using high SMAS techniques, I do not see the need to extend dissection beyond what can be readily accomplished with less swelling and less risk. Since one of the objectives of facelift is elevation of deeper tissues to accommodate removal of skin laxity, a subperiosteal approach would have to be combined with a SMAS approach to allow for this step. Lastly, the chances of looking unnatural with a subperiosteal approach are increased.

Philip S. Schoenfeld, MD, FACS · Answer

I think the first question one has to ask is why the subperiosteal midface lift has been recommended for them.  When the procedure is performed correctly the aesthetic result is very striking and does not cause a distorted look once swelling has resolved.  The most common complication is prolonged edema but I have not experienced any of the other issues you have mentioned.  Having said that, I have found that a deep plane face lift with midface suspension is also extremely effective.  I love fat injections to the midface as well, however, midface elevation is still superior to fat injections alone.

John L. Burns Jr., MD · Answer

A subperiosteal plane is very difficult to suspend.  The swelling is generally extensive and long lasting.  This has not proven to be a widely practiced technique for these and other reasons.

Subperiosteal midface lift: why are surgeons still doing this?

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Subperiosteal midface lift: why are surgeons still doing this?

Answers (10)

Answer: Mid face lifting

Answer: Mid face lifting

Answer: Facelift

Answer: Facelift

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Everything you need to know about Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.