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Special Topics |

Evolution of Midface Rejuvenation

Robert J. DeFatta, MD, PhD; Edwin F. Williams III, MD
Arch Facial Plast Surg. 2009;11(1):6-12. doi:10.1001/archfaci.11.1.6.
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ABSTRACT

Age is the most significant factor contributing to the overall change in the appearance of an individual's facial features over time. This gradual process of structural weakening of the face begins during the third decade and continues to worsen during the remainder of an individual's lifetime. In this article we discuss how the approach to midface rejuvenation has evolved over time owing to our increased understanding of the aging process. In addition, we discuss specific techniques that we employ that have helped us achieve more natural and lasting results.

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Figure 1.

Aging process in the lower eyelids and midface. A, An example of a youthful eyelid and midface in which the orbital septum of the lower eyelid is still taut and there is no laxity in either the orbicularis retaining ligaments or the zygomaticocutaneous ligaments. B, With age, orbital fat begins to pseudoherniate through a weakened septum owing to laxity in the orbicularis retaining ligaments and the additional laxity of the zygomaticocutaneous ligaments. In addition, the malar fat pad begins to descend.

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Figure 2.

Aging process in the fifth decade.

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Figure 3.

Aging process in the eighth decade.

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Figure 4.

Youthful face vs aging face. Note how the increased laxity in the orbicularis retaining ligaments and the zygomaticocutaneous ligaments ultimately results in a descent of the lid-cheek junction and increased vertical length of the lower eyelid. Also, the malar fat pads descend, resulting in a loss in the cheek prominence, a tear trough eyelid deformity, and the appearance of prominent nasolabial folds.

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Figure 5.

Midface rejuvenation without volume restoration. This is an example of a patient at 1 year after surgery in which the midface and lower face were addressed through standard techniques. Note that although the patient had effective repositioning of the ptotic soft tissues of the midface, she still experienced a loss of volume in the lower eyelids and the midface. Preoperative (A) and postoperative (B) lateral views. Preoperative (C) and postoperative (D) oblique views. Preoperative (E) and postoperative (F) front views.

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Figure 6.

Lipotransfer to the midface. To restore volume, fat is transferred to the lower eyelids, the distribution of the zygomaticus major and minor muscles, the nasolabial folds, and the marionette lines.

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Figure 7.

Surgical results following midface rejuvenation procedure and lipotransfer. A, The patient before her surgical intervention. B, One year after her midface-lift, which was augmented with lipotransfer. Note how the added volume of the lipotransfer helps to restore the youthful appearance. C, The patient at 2-year follow-up. Note that there has been some volume loss, but most of the volume was still present at this time, helping to restore the patient's youthful appearance.

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Figure 8.

Volume restoration through treatment with Radiesse (BioForm Medical Inc, San Mateo, California). A, The patient before volume restoration. B, Four months after injection of 4 mL of Radiesse to the lower eyelids, the nasolabial folds, and marionette lines.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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