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Handchir Mikrochir Plast Chir 2014; 46(04): 224-233
DOI: 10.1055/s-0034-1385927
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Midface Lift: Our Current Approaches

Verjüngung des Mittelgesichts: Aktuelle Ansätze
G. Botti
1   Plastic Surgery, Villa Bella Clinic, Saló, Italy
,
C. Botti
1   Plastic Surgery, Villa Bella Clinic, Saló, Italy
› Institutsangaben
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Publikationsverlauf

received 23. Juli 2014

accepted 23. Juli 2014

Publikationsdatum:
27. August 2014 (online)

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Abstract

In the last few years, surgery of the ageing face seems to have shifted from tissue uplifting and tightening to mere filling. We do not agree with this trend. We are positive that ageing brings about 2 basic phenomena: on one hand bone and fat volume reduction, whilst on the other a deterioration of the skin lining (elastosis) leading to an increase in its compliance and extension. We therefore deem of the utmost importance to couple soft tissue filling with indispensable tightening and repositioning together with resection of overabundant skin. For what concerns the mid-face area in particular, we suggest to resort to 3 different lifting techniques, according to the kind of defect to be treated. It is important to take the right pulling vector into consideration as well as the need of skin excess removal. The procedures can be tailored to suit any peculiar need such as malar bag, lower lid border malposition, tear trough deformity, etc. Different cases will be taken into consideration as examples of the various indications and techniques.

Zusammenfassung

In der Chirurgie des alternden Gesichts wurde in den letzten Jahren zunehmend statt Gewebeanhebung und Gewebestraffung lediglich die Gewebeunterspritzung durchgeführt. Die Autoren unterstützen diesen Trend nicht. Wir sind vielmehr der Ansicht, dass Alterung 2 grundlegende Phänomene mit sich bringt: einerseits eine Reduktion des Knochen- und Fettvolumens, andererseits eine Verschlechterung des elastischen Eigenschaften der Haut, was zu höherer Dehnbarkeit und Dehnung führt. Wir sind daher überzeugt, dass die Unterspritzung von Weichgewebe im Gesicht generell mit der dafür erforderlichen Straffung und Neupositionierung mit einer Resektion der überschüssigen Haut gekoppelt werden sollte. Insbesondere in Bezug auf den Mittelgesichtsbereich schlagen wir, je nach zu behandelndem Problem, 3 verschiedene Lifting-Techniken vor. Entscheidend sind sowohl die richtigen Zugvektoren als auch die Notwendigkeit einer Entfernung der überschüssigen Haut zu berücksichtigen. Die Verfahren können auf spezielle Bedürfnisse angepasst werden, wie im Bereich des Jochbeins, Unterlidfehlstellung, Tränensackdeformation usw.

Für die jeweiligen Indikationen und Techniken werden in dieser Übersichtsarbeit beispielhaft verschiedene Fälle vorgestellt.

Key words

midface lift - tissue filling - ageing - plastic surgery

Schlüsselwörter

Mittelgesichtsstraffung - Gewebeunterspritzung - Alterung - Plastische Chirurgie
 

  • References

  • 1 Adamson JE, McCraw JB, Carraway JH. Use of a muscle flap in lower blepharoplasty. Plast Reconstr Surg 1979; 63: 359-363
    CrossrefPubMedGoogle Scholar
  • 2 Adamson PA, Dahiya R, Litner J. Midface Effects of the deep-plane vs the superficial musculoaponeurotic system plication face-lift. Arch Plast Surg 2007; 9: 9-11
    PubMedGoogle Scholar
  • 3 Alsarraf R, To WC, Johnson Jr CM. The deep plane facelift. Facial Plast Surg 2003; 19: 95-106
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 4 Barton Jr FE. The SMAS and the nasolabial fold. Plast Reconstr Surg 1992; 89: 1058-1059
    CrossrefPubMedGoogle Scholar
  • 5 Besins T. The “R.A.R.E.” technique (reverse and repositioning effect): the renaissance of the aging face and neck. Aesthetic Plast Surg 2004; 28: 127-142
    PubMedGoogle Scholar
  • 6 Binder WJ, Schoenrock LD, Terino EO. Augmentation of the malar-submalar/midface. Facial Plast Surg Clin North Am 1994; 2: 265-283
    PubMedGoogle Scholar
  • 7 Botti G, Pelle Ceravolo M. Midface and Neck Aesthetic Plastic Surgery Vol. I/II. Parma, Italy: Acta Medica Edizioni; 2012
    Google Scholar
  • 8 Connell BF, Semlacher RA. Contemporary deep layer facial rejuvenation. Plast Reconstr Surg 1997; 100: 1513-1523
    CrossrefPubMedGoogle Scholar
  • 9 Cornette de Saint-Cyr B, Garey LJ, Maillard GF et al. The vertical midface lift: an improved procedure. J Plast Reconstr Aesthet Surg 2007; 60: 1277-1286
    CrossrefPubMedGoogle Scholar
  • 10 De la Plaza R, Valiente E, Arroyo JM. Supraperosteal lifting of the upper two-thirds of the face. Br J Plast Surg 1991; 44: 325-332
    CrossrefPubMedGoogle Scholar
  • 11 Dempsey P, Oneal RM, Izenberg PH. Subperiosteal brow and midface lifts. Aesthetic Plast Surg 1995; 19: 59-68
    CrossrefPubMedGoogle Scholar
  • 12 Fuente del Campo A. Cirugia reparadora del envejecimiento facial sin cicatrices visables. Cirugia Cirujanos 1993; 60: 123-132
    PubMedGoogle Scholar
  • 13 Hamra ST. Composite rhytidectomy. Plast Reconstr Surg 1992; 90: 1-13
    Google Scholar
  • 14 Hamra ST. The zygorbicular dissection in composite rhytidectomy: an ideal midface plane. Plast Reconstr Surg 1998; 102: 1646-1657
    CrossrefPubMedGoogle Scholar
  • 15 Hinderer UT. The sub-SMAS and subperiosteal rhytidectomy of the forehead and middle third of the face: A new approach to the aging face. Facial Plast Surg 1992; 8: 18-32
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 16 Isse NG. Endoscopic facial rejuvenation. Clin Plast Surg 1997; 24: 213-231
    PubMedGoogle Scholar
  • 17 Ivy EJ, Lorenc ZP, Aston SJ. Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies. Plast Reconstr Surg 1996; 98: 1135-1147
    CrossrefPubMedGoogle Scholar
  • 18 Kamer FM, Mingrone MD. Deep plane rhytidectomy: a personal evolution. Facial Plast Surg Clin North Am 2002; 10: 63-75
    CrossrefPubMedGoogle Scholar
  • 19 Krastinova-Lolov D. Le lifting facial sous-perioste. Ann Chir Plast Esthet 1989; 34: 199-211
    PubMedGoogle Scholar
  • 20 LaFerriere KA, Kilpatrick JK. Transblepharoplasty: subperiosteal approach to rejuvenation of the aging midface. Facial Plast Surg 2003; 19: 157-170
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 21 Le Louarn C, Buthiau D, Buis J. The face recurve concept: medical and surgical applications. Aesthetic Plast Surg 2007; 31: 219-231
    CrossrefPubMedGoogle Scholar
  • 22 Le Lourn C. Midface region: functional anatomy, ageing process, indications and concentric malar lift. Ann Chir Plast Esthet 2009; 54: 411-420
    CrossrefPubMedGoogle Scholar
  • 23 Little JW. Volumetric perceptions in midface aging with altered priorities for rejuvenation. Plast Reconstr Surg 2000; 105: 252-266
    CrossrefPubMedGoogle Scholar
  • 24 McCollough EG, Scurry WC, Shirazi MA. The “midface-lift” as a misnomer for correctly identifying procedures designed to lift and rejuvenate the cheeks and malar regions of the face. Arch Facial Plast Surg 2009; 11: 257-262
    CrossrefPubMedGoogle Scholar
  • 25 Newman J. Safety and efficacy of midface-lifts with an absorbable soft tissue suspension device. Arch Plast Surg 2006; 8: 245-251
    PubMedGoogle Scholar
  • 26 Ortiz-Monasterio F. Aesthetic surgery of the facial skeleton: The forehead. Clin Plast Surg 1991; 18: 19-27
    PubMedGoogle Scholar
  • 27 Owsley JQ. Lifting the malar fat pad for correction of prominent nasolabial folds. Plast Reconstr Surg 1993; 91: 463-470
    CrossrefPubMedGoogle Scholar
  • 28 Paul MD, Calvert JW, Evans GRD. The evolution of the midface lift in aesthetic plastic surgery. Plast Reconstr Surg 2006; 117: 1809-1827
    CrossrefPubMedGoogle Scholar
  • 29 Psillakis JM, Rumley TO, Camargos A. Subperiosteal approach as an improved concept for correction of the aging face. Plast Reconstr Surg 1988; 82: 383-394
    CrossrefPubMedGoogle Scholar
  • 30 Quatela VC, Jacono AA. The extended centrolateral endoscopic midface lift. Facial Plast Surg 2003; 19: 199-208
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Ramirez OM, Maillard GF, Musolas A. The extended subperiosteal face lift: a definitive soft-tissue remodeling for facial rejuvenation. Plast Reconstr Surg 1991; 88: 227-236
    CrossrefPubMedGoogle Scholar
  • 32 Ramirez OM. Three-dimensional endoscopic midface enhancement: a personal quest for the ideal cheek rejuvenation. Plast Reconstr Surg 2002; 109: 329-349
    CrossrefPubMedGoogle Scholar
  • 33 Santana PSM. Metodologia craneomaxilofacial en ritidoplastias. Cirurgia Plastica Ibero-Latino Americana 1984; 10: 321-350
    PubMedGoogle Scholar
  • 34 Tapia A, Ferreria B, Blanch A. A subperiostic lifting. Aesthetic Plast Surg 1991; 15: 155-160
    CrossrefPubMedGoogle Scholar
  • 35 Williams III EF, Vargas H, Dahiya R et al. Midfacial rejuvenation via a minimal incision brow-lift approach. Arch Facial Plast Surg 2003; 5: 470-478
    CrossrefPubMedGoogle Scholar
  • 36 Williams JV. Transblepharoplasty endoscopic subperiosteal mid face lift. Plast Reconstr Surg 2002; 110: 1769-1777
    CrossrefPubMedGoogle Scholar