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Surgical Technique |

A Simplified Approach to Midface Aging

Ryan N. Heffelfinger, MD; Keith E. Blackwell, MD; Jeffrey Rawnsley, MD; Gregory S. Keller, MD
Arch Facial Plast Surg. 2007;9(1):48-55. doi:10.1001/archfaci.9.1.48.
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We review herein our experience with subperiosteal midface-lifting under direct vision with a simple fixation technique. The technical aspects of the procedure are described in detail. A total of 121 patients underwent midface-lifting and meloplication with the 82/18 L-lactide/glycolide device (Coapt Endotine Midface ST 4.5; Coapt Technologies, Palo Alto, Calif) by both the senior (G.S.K.) and junior (R.N.H.) authors. The senior author's experience included 110 patients over a 26-month period. Thirty-two of these cases were isolated procedures. The other 78 were performed in conjunction with various procedures, most commonly rhytidectomy. There were no revisions during this period. Two cases of “puckering” were noted. Both were immediately corrected, one with fat injection and one with poly-L-lactic acid injection (Sculptra; Dermik Aesthetics, distributed by Besse Medical Supply, West Chester, Ohio). The junior author's experience included 11 cases over an 8-month period. Two cases of asymmetry were noted. One was corrected with fat injection, and the other required revision. Subperiosteal midface-lifting and meloplication using the Coapt Endotine Midface ST 4.5 device is a simple, effective technique that can be quickly learned and applied.

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Figure 1.

Illustration demonstrates the process of midface aging. As the malar fat pad descends, the nasolabial fold is accentuated. The orbital rim is left covered only by thin eyelid skin, and the tear-trough deformity becomes apparent.

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Figure 2.

Illustration shows the location of incision and plane of dissection. This plane is between the deep temporal fascia (DTF) and the temporoparietal fascia (TPF).

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Figure 3.

Illustration depicts the upper (A) and lower (B) dissection. The subperiosteal plane is entered over the malar eminence, remaining medial to and preserving the medial zygomaticotemporal nerve (MZTN). The medial zygomaticotemporal vein (MZTV) is often encountered and is cauterized at its deep aspect and transected. LZTN indicates lateral zygomaticotemporal nerve; ZFN, zygomaticofacial nerve.

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Figure 4.

Preoperative (A and C) and 10-month postoperative (B and D) photographs of a female patient who underwent subperiosteal midface-lift and laser skin tightening of the lower face and neck (3 treatment sessions).

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Figure 5.

Preoperative (A and C) and postoperative (B and D) photographs of a female patient who underwent a midface-lift as an isolated procedure (4-month follow-up period).

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Figure 6.

Preoperative (A) and postoperative (B) photographs of a female patient who underwent subperiosteal midface-lift, upper and lower blepharoplasty, face-lift, and a skin rejuvenation program (6-month follow-up period); preoperative (C) and 2-month postoperative (D) views of a male patient after subperiosteal midface-lift in conjunction with face-lift and upper blepharoplasty.

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Figure 7.

Preoperative (A and C) and 12-month postoperative (B and D) views of a female patient after subperiosteal midface-lift in conjunction with face-lift, endoscopic brow-lift, and blepharoplasty.

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Figure 8.

Preoperative (A) and 9-month postoperative (B) photographs of a female patient after subperiosteal midface-lift in conjunction with an endoscopic brow-lift and face-lift.

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