In the present study, several of the principles previously described by Hamra2 hold true, illustrating the advantage of the transtemporal midface-lift over the DP face-lift on the NLF. The ML fixation suture resulted in a statistically significant greater elevation of the NLF over the DP suspension suture of 43.2% (3.2 mm) (P = .03). The placement of this suture above the NLF in the melolabial mound also helped efface the NLF, not deepen it, as might be expected if placed in the NLF. First, the midface-lift is a wide subperiosteal dissection that allows for the midface to be positioned as a composite flap of skin, malar fat, muscle, and periosteum in a more vertical orientation. Second, the ML suture is immediately adjacent to the NLF and, based on the amount of movement and principles of flap biomechanics, offers a clear advantage over the DP suspension suture while potentially offering a more long-term effect. Although the average improvement in the elevation of the NLF was higher when comparing the ML suture with the ZF suture and the ZF suture with the DP suture (2.4 mm and 0.8 mm, respectively), the difference was not statistically significant (P = .10 and P = .32, respectively). This is most likely due to the low power of the study, and both of these trends would most likely reach statistical significance with a larger series. Despite the low power of the study, the effect of the ML suture over the DP suture was significant, speaking to the enormous advantage the ML suture offers in elevating the midfacial mound and NLF.