ABSTRACT
The midface is an important new area in facial rejuvenation. Rejuvenation of the midface
is necessary to achieve harmonious rejuvenation of the face. The extent of “lift”
to be achieved with midfacial elevation is very limited. Excessive elevation of midfacial
tissues results in vertical shortening of the lower eyelid, round eye deformity, and
ectropion. In patients with previous blepharoplasty or midfacelifts, minimal or no
tissue can be resected. Instead, any midfacial advancement achieved is required to
reconstruct the lower eyelid form and allow a canthoplasty or canthopexy to heal without
undue downward traction on the repair. The surgeon must elevate the midface tissue
in a very limited, safe fashion. Many current approaches to midfacial rejuvenation
exist in a number of anatomic planes, with several fixation techniques. Some surgical
approaches, such as surgery in a suborbicularis plane, may be inherently safer than
others. Aesthetic micromanagement of the lower eyelid position and orbicularis muscle
is possible. A useful test for assessing the amount of available midfacial tissue
is provided.
KEYWORDS
Midfacial rejuvenation - blepharoplasty - aesthetic micromanagement
