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Midface Rejuvenation: A Critical Evaluation of a 7-Year Experience

Pascali, Michele M.D.; Botti, Chiara M.D.; Cervelli, Valerio M.D.; Botti, Giovanni M.D.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 1305–1316
doi: 10.1097/PRS.0000000000001189
Cosmetic: Original Articles
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Background: Although “traditional” face-lifting techniques can achieve excellent improvement along the jawline and neck, they often have little impact on the midface area. Thus, many different types of procedures have been developed to provide rejuvenation in this region, usually contemplating various dissection planes, incisions, and suspension vectors.

Methods: A 7-year observational study of 350 patients undergoing midface lift was analyzed. The authors suspended the midface flap, anchoring to the deep temporal aponeurosis with a suspender-like suture (superolateral vector), or directly to the lower orbital rim with a belt-like suture (superomedial vector). Subjective and objective methods were used to evaluate the results. The subjective methods included a questionnaire completed by the patients. The objective method involved the evaluation of preoperative and postoperative photographs by a three-member jury instructed to compare the “critical” anatomical areas of the midface region: malar eminence, nasojugal groove, nasolabial fold, and jowls in the lower portion of the cheeks. The average follow-up period was 24 months.

Results: High satisfaction was noticeable from the perceptions of both the jury and the patients. Objective evaluation evidenced that midface lift with temporal anchoring was more efficient for the treatment of malar eminence, whereas midface lift with transosseous periorbital anchoring was more efficient for the treatment of nasojugal groove.

Conclusions: The most satisfying aspect of the adopted techniques is a dramatic facial rejuvenation and preservation of the patient’s original youthful identity. Furthermore, choosing the most suitable technique respects the patient’s needs and enables correction of the specific defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Supplemental Digital Content is available in the text.

Rome and Salò, Italy

From the Department of Plastic and Reconstructive Surgery, University of “Tor Vergata”; and the Villa Bella Clinic.

Received for publication July 22, 2014; accepted November 10, 2014.

Disclosure: None of the authors has a financial interest in any of the products or devices mentioned in this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www.PRSJournal.com).

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Videos” tab to watch.

Michele Pascali, M.D., Department of Plastic and Reconstructive Surgery, University of “Tor Vergata”, V.le Oxford 81, 00133 Rome, Italy, mic.pascali@gmail.com

©2015American Society of Plastic Surgeons