Abstract
Facial aging in the midface has been described to encompass both soft tissue descent
and volumetric change. Currently, there is no established and widely accepted grading
system for midfacial ptosis. We propose a simplified grading system for midfacial
ptosis ranging from mild to severe in terms of Grades I through III. Using this classification
system, we describe an algorithm to help select the facelift approach most appropriate
for each patient. The sub-superficial musculoaponeurotic system rhytidectomy, deep
plane rhytidectomy, and subperiosteal midface lift techniques are described in detail.
The nuances of the selection process also include a discussion on the various approaches
to the orbital fat, namely a transconjunctival lower lid blepharoplasty with skin
pinch versus a lower lid blepharoplasty with fat transposition, as well as the aging
neck. Furthermore, we integrate the addition of postoperative adjunctive procedures
which include injectables, chemical peels, and dermabrasion to address facial rejuvenation
from not only a gravitational aspect but also the volumetric and textural components.
Keywords
midface - facelift - ptosis
