Abstract
Improvements have been made throughout the history of medicine, causing physicians to abandon a technique or medications clearly shown to be suboptimal. Unfortunately, this has not happened with rejuvenative surgery. Conventional lower eyelid procedures continue to include removal of orbital fat in most cases, and facelift procedures remain primarily a lateral vector pull. The unfortunate results of these traditional procedures are becoming easy to recognize. Optimal rejuvenation of the lower eyelid complex should be based on the principle that the contour changes characterizing aging involve not only prolapse of orbital fat, but also descent of the cheek tissues, resulting in accentuation of the orbital rim and tear trough groove. Although the necessity of preserving fat and repositioning the soft tissues of the midface has been widely accepted, there still is wide disagreement among authors as to the best approach and surgical technique. This report describes a surgical technique for lower lid midfacial rejuvenation that is a composite of several previously published approaches with some modifications, particularly in the way the Sub-Superficial Musculo Aponeurotic System (SMAS) fat pad is plicated and the midfacial tissues suspended. The technique is simple and safe, resulting in a pleasing natural midface contour.
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Accioli de Vasconcellos JJ, Brotto JA, Henin D, Vacher C: The fascial planes of the temple and face: an en bloc anatomical study and a plea for consistency. Brit J Plast Surg 56:623–629, 2003
Aiache AE, Ramirez OH: The suborbicularis oculi fat pads: An anatomic and clinical study. Plast Reconstr Surg 95:37–42, 1995
Baylis HI, Goldberg RA, Kerivan KM, Jacobs JL: Blepharoplasty and periorbital surgery. Dermatol Clin 15:635–647, 1997
De Cordier B, de la Torre JI, Al-Hakeem MS, Rosenberg LZ, Costa-Ferreira A, Gardner PM, Fix RJ, Vasconez LO: Rejuvenation ofthe midface by elevating the malar fat pad: Review of technique, cases, and complications. Plast Reconstr Surg 110:1526–1536, 2002
de la Torre JI, Rosenberg LZ, De Cordier BC, Gardner PM, Fix RJ, Vasconez LO: Clinical analysis ofmalar fat pad reelevation. Ann Plast Surg 50:244–248, 2003
De La Plaza R, Valentine E, Arroyo JM: Supraperiosteal lifting ofthe upper two-thirds ofthe face. Br J Plast Surg 44:325–332, 1991
Eder H: Importance off at conservation in lower blepharoplasty. Aesth Plast Surg 21:168–174, 1997
Fayman MS, Potgieter E: Zygomaticus major advancement as an adjunct to lower blepharoplasty. Aesth Plast Surg 26:26–30, 2002
Freeman MS: Rejuvenation ofthe midface. Facial Plast Surg 19:223–236, 2003
Giambrone H: The ultimate in facial rejuvenation: The mid–face-lift. Plast Surg Nurs 21:147–150, 2001
Goldberg RA: Transconjunctival orbital fat repositioning: Transposition oforbital fat pedicles into a subperiosteal pocket. Plast Reconstr Surg 105:743–748, 2000
Goldberg RA, Edelstein C, Balch K, Shorr N: Fat repositioning in lower eyelid blepharoplasty. Semin Ophthalmol 13:103–106, 1998
Goldberg RA, Edelstein C, Shorr N: Fat repositioning in lower blepharoplasty to maintain infraorbital rim contour. Facial Plast Surg 15:225–229, 1999
Gubisch W: The value ofvarious techniques for esthetic correction ofthe lower eyelid. Handchir Mikrochir Plast Chir 31:113–120, 1999
Hamra ST: Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg 96:354–362, 1995
Hamra ST: Composite rhytidectomy. Plast Reconstr Surg 90:1–13, 1992
Hamra ST: Prevention and correction of the “face-lifted” appearance. Facial Plast Surg 16:215–229, 2000
Hamra ST: Prevention and correction of the “face-lifted” appearance. Facial Plast Surg 16:215–229, 2000
Hamra ST: The deep-plane rhytidectomy. Plast Reconstr Surg 86:53–61, 1990
Hamra ST: The role of orbital fat preservation in facial aesthetic surgery: A new concept. Clin Plast Surg 23:17–28, 1996
Hinderer UT: Vertical preperiosteal rejuvenation ofthe frame of the eyelids and midface. Plast Reconstr Surg 104:1482–1499, 1999
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 98:1135–1143, 1996
Jauffret JL, Magalon G: Volume and facial rejuvenation. Ann Chir Plast Aesthet 48:332–338, 2003
LaFerriere KA, Kilpatrick JK: Transblepharoplasty: Subperiosteal approach to rejuvenation ofthe aging midface. Facial Plast Surg 19:157–170, 2003
Li S, Liu Y, Li Y: Lower lid blepharoplasty by using the principles ofplastic surgery and the technique of orbital fat release. Zhonghua Zheng Xing Wai Ke Za Zhi 16:171–173, 2000
Maillard GF: Arcus marginalis release. Plast Reconstr Surg 98:910–911, 1996
Matarasso A: Facialplasty. Dermatol Clin 15:649–658, 1997
Millman AL, Williams JD, Romo T III, Taggert N: Septal-myocutaneous flap technique for lower lid blepharoplasty. Ophthal Plast Reconstr Surg 13:84–89, 1997
Mitz V, Peyronie M: The musculoaponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg 58:80–88, 1976
Mladick RA: The muscle-suspension lower blepharoplasty. Plast Reconstr Surg 64:171–175, 1979
Muhlbauer W, Holm C: Orbital septorhaphy for the correction ofbaggy upper and lower eyelids. Aesth Plast Surg 24:418–423, 2000
Pessa JE, Desvigne LD, Lambros VS, Nimerick J, Sugunan B, Zadoo VP: Changes in ocular globe-toorbital rim position with age: Implications for aesthetic blepharoplasty ofthe lower eyelids. Aesth Plast Surg 23:337–342, 1999
Ramirez OM: High tech face-lift. Aesth Plast Surg 22:318–328, 1998
Ramirez OM: Three-dimensional endoscopic midface enhancement: A personal quest for the ideal cheek rejuvenation. Plast Reconstr Surg 109:329–340, 2002
Ramirez OM, Pozner JN: Subperiosteal minimally invasive laser endoscopic rhytidectomy: The SMILE facelift. Aesth Plast Surg 20:463–470, 1996
Tebbetts JB: SMAS fixation to the facial skeleton: Rationale and results [discussion]. Plast Reconstr Surg 100:1834, 1997
Tessier P: New face lifts: preface. Ann Chir Plast Esthet 20:463–470, 1989
Turk JB, Goldman A: SOOF lift and lateral retinacular canthoplasty. Facial Plast Surg 17:37–48, 2001
Wang J, Jia Z, Lu W: Orbicularis oculi muscle suspension and orbital septum fixation in blepharoplasty. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 15:265–266, 1999
Xing X, Ouyang T, Sun L: Orbital fat preservation and orbicularis muscle flap suspension for lower eyelid pouches. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 15:135–137, 1999
YousifNJ, Mendelson BC: Anatomy ofthe midface. Clin Plast Surg 22:227–240, 1995
YousifNJ, Sonderman P, Dzwierzynsky WW, Larson DL: Anatomic considerations in transconjunctival blepharoplasty. Plast Reconstr Surg 96:1271–1276, 1995
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Atiyeh, B.S., Hayek, S.N. Combined Arcus Marginalis Release, Preseptal Orbicularis Muscle Sling, and SOOF Plication for Midfacial Rejuvenation. Aesth. Plast. Surg. 28, 197–202 (2004). https://doi.org/10.1007/s00266-004-4019-0
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DOI: https://doi.org/10.1007/s00266-004-4019-0