(Right) Youthful contours. (Left) Aged anatomical findings.  

(Right) Youthful contours. (Left) Aged anatomical findings.  

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The subperiosteal midface-lift has benefited from significant technological advances in medicine. The endoscope now allows extensive subperiosteal undermining of facial soft tissue through minimal access incisions. Improved understanding of facial anatomy and the facial aging process now allow repositioning and remodeling of the soft tissue envelop...

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In it's important to keep the continuity of colour, texture and thickness of the tissue in a reconstructed nose. The zigomatic cheek flap is an axial pattern flap that, when is properly designed, can follow the natural existing contour lines such as the nasolabial fold and the lower eyelid border. It gets an almost exactly replacement of matching s...

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... Patient expectations are also getting higher over time, where lifted temples and brows, together with a fuller anterior upper cheek and slimmer lower cheek are essential [2]. Unlike before, these relatively younger patients target ''beautification'' rather than ''rejuvenation'' or erasing agerelated symptoms [2][3][4]. Moreover, these highly demanding patients are seeking scarless procedures, which makes transtemporal/transoral approaches to the temple and midface areas more preferable than the transpalpebral approach. ...
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The surge in the popularity of midface and temporal lifting procedures can be attributed to evolving social media trends and heightened patient expectations, particularly among younger individuals seeking “beautification” rather than traditional rejuvenation. Scarless techniques, such as transtemporal/transoral approaches, are increasingly preferred. This study aimed to combine the advantages of both superficial and deep dissection planes in midface and temporal lifting procedures. This retrospective study included 184 patients who underwent surgery using a dual-plane midface and temporal lift technique. Preoperative and postoperative assessments, including P1/P2 ratio calculations, were performed to evaluate volumetric distribution in the midface. The study cohort exhibited a significant improvement in the P1/P2 ratio postoperatively (p < 0.05), indicating successful volume redistribution. Complications, including hypoesthesia, bruising, and infection, were managed effectively. Minor asymmetries were observed, with revisions offered, but declined by the patient. This technique offers hidden incisions and reduces the risk of scar-related complications, making it suitable for patients seeking facial enhancement. Addressing the tear trough area and the lateral canthus provides comprehensive facial rejuvenation. The dual-plane approach facilitates both skin mobilization and volume shift, yielding favorable aesthetic outcomes. The dual-plane midface and temporal lift technique presented in this study offers a bi-vectoral approach to midfacial lifting, suitable for both beautification and rejuvenation goals. Despite the potential limitations, including infection risk, this method is an effective option for facial enhancement. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
... • We slide the fat compartments upwards again with a reduction in the lid-cheek distance 1,2 without opening the lower eyelid. The other subperiostal or supraperiostal facelift [25][26][27][28][29][30][31][32] accompanied by an infraciliary incision to resect excess eyelid skin. The fat compartment flap slides upwards and resumes its position on the maxillomalar bone margin. ...
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The mirror facelift1,2 is a new concept of mid-face rejuvenation that we apply during the preoperative consultation to explain and show the patient the possible results that can be achieved postoperatively and have this result stay stable over time and in different positions. It is characterized by (1) the use of a mirror during the preoperation visit and the taking of pictures from different angles, allowing for a precise analysis of the redistribution of the facial soft tissues on each hemi-skeleton; (2) the Divaris et al2 locked cheek lift technique (Locked Cheek-Lift), which is done with 2 vectors that achieve a tri-dimensional redistribution of the soft tissues; and (3) postoperative photographs which are very useful in precisely evaluating the results and comparing them with the preoperative pictures. Methods: Two hundred and sixty patients (216 women and 44 men), average age 53 (34 to 73 years old), were operated on between 2010 and 2016, applying the concept of mirror lift in the consultation to show the patients the expected possible results after the surgery. The patients see for themselves the deterioration of the facial condition (looking older) with the anti-mirror position as well as the younger appearance of the face following the mirror position. Surgically, the locked cheek lift technique was performed by the same surgeons. The follow-up 1 year later was done by the same team. The fat compartment positions were evaluated during this period. Results: The fat compartments' stability was evaluated 3 months and a year postoperatively to assess the stability of the result over time. The mean value is 4.62 out of 5 in anti-mirror position before surgery and 1 year postoperatively. The mean value is 4.34 out of 5 after 1 year measured in both standing and lying positions. Postoperative edema and ecchymosis were limited. Conclusions: The concept of the Mirror Facelift is to precisely reposition the soft tissues of the face on the bone structure by correcting the fat compartments that have migrated over years. It harmoniously redistributes the soft tissues without any palpebral cutaneous incision, thus allowing for a short recovery period free of any risk of palpebral complications.
... All rejuvenation surgical techniques [7][8][9][10][11][12][13][14] for the middle third are performed on a vertical axis to achieve a natural correction by mobilizing the soft tissue along the skeletal support. ...
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Background: Many recent advances in face lift techniques have been made to reverse the aging process of the mid-face. In this study, we present a new technique by which mid-face rejuvenation can be achieved in double-angle vectors and allows adaption to the underlying bony structure. The locked cheek lift (LCL) allows effective, simple and rapid lifting of the malar fat pad in two planes. Correction of the curvature of the face and reduction of the height of lid cheek junction distance can be achieved without an incision at the lower eyelid. Methods: In total, 115 patients (77 females and 38 males) have been operated on using the LCL technique by a single surgeon; patient ages ranged between 37 and 71 years old (average = 51). Follow-up was performed by the same team for a year postoperatively. The facial expression and lid cheek distance have been evaluated during this period. Results: After a year from the operation, the lid cheek distance correction was maintained in 95.7% of the cases, with stable position of the ascended malar fat pad. Postoperative edema and ecchymosis were limited. Conclusion: LCL is an effective, simple and rapid surgical technique, which is capable of correcting the cheek gravitational migration, reducing the lid cheek distance (LCD), maintaining the ascended stable malar fat pad for a long time with a short recovery period and minimal risk of complications. Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
... This technique rapidly developed and was accepted as a suitable procedure for lifting the upper two thirds of the face. There are three main landmarks in subperiosteal facelift [33]: ...
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The effects of aging on skin, including thinning and loss of muscle tone, result in a flabby or drooping appearance of the face. The demands of an attractive appearance and smooth skin are wanted all around the world. There are a lot of factors which influence the choice of rejuvenation techniques, including anatomy of the facial skeleton, the severity of aging changes, social and economic status of the patient, and structure of the skin. Facelifting is a facial rejuvenation procedure in which by dissection of subcutaneous layers and different suturing techniques we are able to stretch the skin and make the patient look younger. This chapter presents the technique, current concepts, complications, and indications of facelift surgery.
... Although controversy surrounds whether midface changes are predominantly caused by volume loss secondary to fat and skin atrophy vs tissue descent, the collective research suggests a combination of both reasons. [10][11][12][13][14][15][16] The senior author (D.R.) noted that malar injection in the midface area had secondary effects on the surrounding tissues as well as the naso-labial fold (NLF) and naso-labial crease (NLC). He observed what appeared to be a postinjection lifting of the face associated with recruitment of ptotic tissues and supero-lateral movement of the NLF-NLC junction, in addition to soft-tissue augmentation. ...
... There has been growing interest in recent years among aesthetic surgeons in midface lifting procedures. [12][13][14]16,17 These techniques have been implemented with the fundamental goal of restoring midface volume by resuspending previously ptotic tissues. Although there have been attempts to employ standardized assessment tools, 18,19 in the current study we provide an objective means to analyze 3D volume changes in the midface and the effects on NLF position. ...
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Three-dimensional (3D) changes in the midface following malar calcium hydroxyapatite (CaHa) injection have not been systematically analyzed. The authors analyzed 3D volume changes in midface and naso-labial fold (NLF) volume, as well as lateral movement in the NLF/naso-labial crease (NLC) junction following malar injection of CaHa in a cadaver model. A single surgeon injected CaHa in the supraperiosteal plane. Sequential images were obtained with the VECTRA 3D system pre- and post-1.5- and 3-cc CaHa injections. All measurements were performed by a single examiner. Injection location was verified anatomically. Injections were performed in 16 fresh cadaver hemi-faces. Maximal increases in projection were centered on the malar injection site, with associated decreases in projection and volume in the infero-medial locations. Relative mean increases in volume of 3.16 cc and 4.94 cc were observed following the 1.5-cc and 3-cc injections, respectively. There was a relative decrease in the volume of the NLF of -0.3 cc and -0.4 cc following the 1.5- and 3-cc injections, respectively. Injection of CaHa was associated with lateral movements of the NLF-NLC junction at the level of the nasal sill, philtral columns, and oral commissure, measuring 2.7, 2.5, and 1.9 mm and 2.8, 2.9, and 2.4 mm following the 1.5- and 3-cc injections, respectively. Anatomical dissection verified the location in the supraperiosteal space and within the middle malar fat pad. Following malar CaHa injection, 3D photographic analysis showed a measureable lifting effect with recruitment of ptotic tissue and lateral movement of the NLF-NLC junction in a cadaver model. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.
... Bei der Weichteilsus- pension werden die Weichteile auf einem festen Verankerungspunkt ohne direkten Kontakt -also indirekt -befestigt. Die abgesunkenen Weichteile werden vorab aufwendig subperiostal mobilisiert und danach mit einem Suspensionslift fixiert [1,12,15]. ...
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Background The first signs of elasticity and volume loss arise in the midface region which has, therefore, become increasingly more important in facial surgery. Question By which means and techniques can midface lifting be optimized? Methods Temporal endoscopic midface lifting is a new method by which the classical endoscopic forehead and temporal lobe lifting can be extended to the whole face. In this context the temporal subcutaneous musculoaponeurotic system (SMAS) should be seen as the “guiding rail”. The facial areas are linked using a joint endoscopic operative preparation space so that a pulley system effect is formed down to the jaws and neck. Special techniques are used for temporal flap formation and anchorage as well as lifting of the malar/submalar fat deposits. A supporting suspension lift with suture loops is additionally installed. Conclusion Due to the short preparative approach and the operative safety in the nerve-free Epi-SMAS layer, using these new methods visible scars and risks can be avoided, operation times can be reduced and the social competence of patients can be restored. The face appears younger and very natural. The procedure is a sophisticated new approach to incisionless, atraumatic facial rejuvenation
Article
Background Temporal facelift (TFL) is an innovative technique for lifting the upper and mid-face. It is characterized by a unique dissection plane above the subgaleal fascia, which seamlessly transitions into the sub-superficial muscular aponeurotic system (SMAS) layer in the mid-face. This approach enables comprehensive mid-face elevation, robust canthopexy, and a significant brow lift in various vectors. Objectives The authors present their experience with 250 TFL procedures over a period of 6 years. Patients and Methods This retrospective study analyzed 250 of 441 patients who underwent TFL surgery. The surgical procedures, conducted under general anesthesia by a senior surgeon following the TFL method, involved a vertical-vector deep-plane mid-face lift, canthopexy, and brow-lift triad. Close monitoring of complications and detailed photographic documentation of the outcomes were performed. Postoperative care included taping the operation area to reduce swelling, with subsequent follow-up examinations and interventions such as lymphatic massage and botulinum toxin injections for asymmetric brow movements or steroid injections for excessive mid-face swelling. Results Among 250 patients (248 female, 2 male; mean age, 37 y), unilateral neuropraxia of the frontal branch of the facial nerve occurred in 5.6% and resolved spontaneously within 2.8 months. Persistent dimples (2.8%) resolved by the fifth postoperative month. Six patients (2.4%) underwent revision surgery with no observed complications like hematoma, necrosis, infection, or seroma. Conclusions The TFL technique represents a significant advancement in upper and mid-face lifting procedures and offers several advantages over the traditional methods.
Article
Lifting procedures of the upper face have gained significant popularity, and various methods and dissection planes have been described. The deep temporalis fascia (DTF) is a crucial structure for securing lifting sutures and allowing horizontal tissue vectorization. However, achieving vertical eyebrow lifting often requires bone maneuvers and introduces potential complications. This letter proposes a novel multiplanar dissection method for the temporal and forehead regions, obviating the need for bone maneuvers in lifting suture fixations. The presence of the subgaleal fascia in the temporal region has been identified, in addition to the DTF and superficial temporal fascia. Furthermore the superficial temporal fascia is divided into 3 layers, with attention paid to their medial connection with the structures of the forehead. Surgical techniques involve meticulous dissection down to the DTF and identification of the subgaleal fascia for lateral temporal dissection or transition to the subplane of the epicranial aponeurosis for forehead lifting. By leaving a thick layer, the subplane of the epicranial aponeurosis during forehead lifting eliminates the need for drilling and reduces the risk of relapse. The described multiplanar dissection method enhances the safety and effectiveness of forehead lift procedures, offers a viable alternative to bone drilling, minimizes flap-related complications, and provides valuable insights for facial rejuvenation surgery.
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Facial feminization surgery includes a series of procedures that aim to attenuate the masculine features of the face and make the face more feminine and harmonic. During the past few years, several feminization techniques have been developed or adapted to this discipline. The current intervention of the forehead for feminization is based on the setback of the anterior wall of the frontal sinus and the remodeling of the supraorbital and glabellar region, associated to brow lift and hairline advancement. Primary forehead feminization yields high patient satisfaction, quality of life, and aesthetic outcomes, with few complications. Despite this, secondary forehead lift in feminization surgery has grown rapidly in recents years due to two main reasons: 1) patients that had their primary forehead surgery five or more years ago kept aging; 2) there was also a great increase in the primary surgeries, which also comes along of increase of unsatisfied patients that want a revision. In the present study, we will present our current approach for secondary forehead lift in transgender women and tips to avoid a revision when performing the primary forehead reconstruction.