The Tangled Web of Midface Rejuvenation

Posted on March 15, 2013 in Endoscopic Facelift, Cosmetic Procedures

The midface, in aesthetic and anatomic terms, is the part of the face from the lower eyelids to the upper lip. At first glance, it may not seem that there is a lot going on here. However, more careful analysis shows that aging in the midface is complicated and multifactorial. In addition, changes here play an extremely important part in the overall aesthetic changes of the aging face. The subtle but complex anatomical and functional issues of the midface have inspired a similarly complex web of surgical, non-surgical, and minimally-invasive treatments. This includes everything from the nearly ubiquitous Botox® Cosmetic and soft-tissue fillers, to less commonly performed operations like the endoscopic midface lift.

As you can imagine, evaluating the results of the myriad midface rejuvenation treatments is extremely difficult for patients. In fact, it has also been difficult for plastic surgeons! As an attempt to bring some clarity, at least for the surgical and minimally-invasive approaches, Dr. Andrew Jacono and I have published an article in JAMA Facial Plastic Surgery (http://archfaci.jamanetwork.com/article.aspx?articleid=1558176). In this study, we present a comprehensive evaluation of different surgical techniques, including extended lower lid blepharoplasty, facial fat grafting, endoscopic midface lift, and deep plane facelift, alone and in combination. Perhaps most importantly, we chose as our outcome measure the only outcome that really matters in aesthetic surgery – patient satisfaction with the results.

Extensive analysis of data from 150 patients who underwent midface rejuvenation procedures revealed a few important points. First, about one third of patients required a combined approach owing to the complex nature of the aging midface. Second, facial fat grafting alone had the highest rate of dissatisfaction among patients, while extended lower blepharoplasty (lower eyelid lift) with orbital fat preservation and transposition had the highest rate of satisfaction. And finally, in patients with certain anatomic issues (such as a relatively flat cheekbone area), a combination of lifting and volumizing techniques (either with fat or with implants) is the key to success.