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Periorbital Skeletal Augmentation to Improve Blepharoplasty and Midfacial Results

Yaremchuk, Michael J., M.D.; Kahn, David M., M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 2151-2160
doi: 10.1097/PRS.0b013e3181bcf5bc

Background: Narrow palpebral fissures, short lower lids, and full cheeks are hallmarks of youthful periorbita. The presence of these features is predicated on a convex upper midface skeleton. Faces whose midface skeletons are flat or concave do not manifest these youthful attributes, tend to age prematurely, and are prone to lower lid malposition after blepharoplasty.

Methods: Augmentation of the infraorbital rim with alloplastic implants can provide convexity to the deficient upper midface skeleton. Suspension of the cheek soft tissues (subperiosteal midface lift) on this now supportive framework narrows the palpebral fissure, shortens the lower lid, and gives fullness to the cheek. The addition of lateral canthopexy to skeletal augmentation and subperiosteal midface lift can restore lower lid position when previous blepharoplasty has resulted in lower lid malposition in patients with deficient midface skeletons.

Results: This concept has been utilized in 87 patients (65 female, 22 male) over the last 7 years. Of these 87 patients, four patients (5 percent) required revision surgery to correct implant malposition or prominence. Three patients (3 percent) required implant removal to treat infection. Implants were later replaced in two of these three patients.

Conclusions: Augmentation of the infraorbital rim with alloplastic implants provides convexity to the upper midface skeleton. Together with lower lid and midface soft-tissue suspension, it creates or restores youthful periorbital aesthetics.

Boston, Mass., and Palo Alto, Calif.

From the Division of Plastic Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, and Division of Plastic Surgery, Department of Surgery, Stanford School of Medicine

Received for publication November 12, 2008; accepted June 16, 2009.

Disclosure:Dr. Yaremchuk is a consultant for Porex Surgical, which makes facial implants described in this article. Dr. Kahn has no financial interests to declare in relation to the content of this article.

Michael J. Yaremchuk, M.D., 15 Parkman Street, Massachusetts General Hospital, Boston, Mass. 02114,

©2009American Society of Plastic Surgeons