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Trinity Lift: A Unique Technique for Endoscopic Midface and Lower Periorbital Unit Lift

  • Original Article
  • Facial Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

A harmonious face is defined in terms of a balanced relationship among all facial tissues. This balance among skin, fat, muscle, and bone is lost with aging as progressive changes occur in their volume, shape, position, and consistency. Aging of the human face generally starts in the third decade of life, mainly in the midface and periorbital areas. Traditional face-lifting surgeries result in minimal improvements in the midface area. Various techniques have been developed using different dissection planes and vectors with different forms of incision, including endoscopic techniques.

Methods

We attempted to combine endoscopic subperiosteal dissection techniques with the percutaneous needle technique, especially in young- to middle-aged patients. We aim to share technical details of our preferred suspension and fixation method for an endoscopic midface lift with the aid of a percutaneous needle and to present the outcomes of this particular technique in 75 patients.

Results

Significant rejuvenation of the nasojugal groove was achieved, and patient satisfaction was high. All cases exhibited satisfactory, symmetrical, and stable elevation of the midface. None of the patients required a second surgery.

Conclusion

Trinity lift allowed for stronger, easier, and faster application of sutures during endoscopic facial surgery without any other mucosal or transcutaneous incisions.

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 Table of Contents or the online Instructions to Authors www.springer.com/00266.

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References

  1. Psillakis JM, Rumley TO, Camargos A (1988) Subperiosteal approach as an improved concept for correction of the aging face. Plast Reconstr Surg 82:383–394. https://doi.org/10.1097/00006534-198809000-00001

    Article  CAS  PubMed  Google Scholar 

  2. Mendelson BC, Muzaffar AR, Adams WP (2002) Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg 110:885–896. https://doi.org/10.1097/00006534-200209010-00026

    Article  PubMed  Google Scholar 

  3. Owsley JQ, Zweifler M (2002) Midface lift of the malar fat pad: technical advances. Plast Reconstr Surg 110:674–685. https://doi.org/10.1097/00006534-200208000-00048

    Article  PubMed  Google Scholar 

  4. Owsley JQ, Roberts CL (2008) Some anatomical observations on midface aging and long-term results of surgical treatment. Plast Reconstr Surg 121:258–268. https://doi.org/10.1097/01.prs.0000293872.14916.bb

    Article  CAS  PubMed  Google Scholar 

  5. Sasaki GH, Cohen AT (2002) Meloplication of the malar fat pads by percutaneous cable-suture technique for midface rejuvenation: outcome study (392 cases, 6 years’ experience). Plast Reconstr Surg 110:635–654. https://doi.org/10.1097/00006534-200208000-00042

    Article  PubMed  Google Scholar 

  6. DeFatta R, Williams E (2011) Midface lifting: current standards. Facial Plast Surg 27:077–085. https://doi.org/10.1055/s-0030-1270417

    Article  CAS  Google Scholar 

  7. Stuzin JM (2007) Restoring facial shape in face lifting: the role of skeletal support in facial analysis and midface soft-tissue repositioning. Plast Reconstr Surg 119:362–376. https://doi.org/10.1097/01.prs.0000251092.82860.25

    Article  CAS  PubMed  Google Scholar 

  8. Stuzin JM, Rohrich RJ, Dayan E (2019) The facial fat compartments revisited: clinical relevance to subcutaneous dissection and facial deflation in face lifting. Plast Reconstr Surg 144:1070–1078. https://doi.org/10.1097/PRS.0000000000006181

    Article  CAS  PubMed  Google Scholar 

  9. Paul MD, Calvert JW, Evans GRD (2006) The evolution of the midface lift in aesthetic plastic surgery. Plast Reconstr Surg 117:1809–1827. https://doi.org/10.1097/01.prs.0000218839.55122.c0

    Article  CAS  PubMed  Google Scholar 

  10. De Cordier BC, de la Torre JI, Al-Hakeem MS et al (2002) Rejuvenation of the midface by elevating the malar fat pad: review of technique, cases, and complications. Plast Reconstr Surg 110:1526–1536. https://doi.org/10.1097/01.PRS.0000029816.67278.1B

    Article  PubMed  Google Scholar 

  11. Ramirez OM (1994) Endoscopic full facelift. Aesthet Plast Surg 18:363–371. https://doi.org/10.1007/BF00451341

    Article  CAS  Google Scholar 

  12. Boxrud C, Rose JG, Chang L (2007) Closed meloplication percutaneous cable suture technique. Facial Plast Surg Clin N Am 15(191–199):vi. https://doi.org/10.1016/j.fsc.2007.02.001

    Article  Google Scholar 

  13. Quatela V, Azzi J-P, Antunes M (2014) Endoscopic-assisted facelifting. Facial Plast Surg 30:413–421. https://doi.org/10.1055/s-0034-1383559

    Article  CAS  PubMed  Google Scholar 

  14. Marotta JC, Quatela VC (2008) Lower eyelid aesthetics after endoscopic forehead midface-lift. Arch Facial Plast Surg. https://doi.org/10.1001/archfaci.10.4.267

    Article  PubMed  Google Scholar 

  15. Askeroglu U, Pilanci O (2019) A new perspective to the periorbital aesthetics: bella eyes. Aesthet Plast Surg 43:1564–1569. https://doi.org/10.1007/s00266-019-01497-0

    Article  Google Scholar 

  16. de la Fuente A, Franz Hönig J (2005) Transtemporal endoscopic multiplanar upper midface lift (MUM lift). Aesthet Surg J 25:471–480. https://doi.org/10.1016/j.asj.2005.06.003

    Article  PubMed  Google Scholar 

  17. Friedman O (2005) Changes associated with the aging face. Facial Plast Surg Clin N Am 13:371–380. https://doi.org/10.1016/j.fsc.2005.04.004

    Article  Google Scholar 

  18. Lambros V (2007) Observations on periorbital and midface aging. Plast Reconstr Surg 120:1367–1376. https://doi.org/10.1097/01.prs.0000279348.09156.c3

    Article  CAS  PubMed  Google Scholar 

  19. Mendelson B, Wong C-H (2012) Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthet Plast Surg 36:753–760. https://doi.org/10.1007/s00266-012-9904-3

    Article  Google Scholar 

  20. Little JW (2000) Volumetric perceptions in midfacial aging with altered priorities for rejuvenation. Plast Reconstr Surg 105:252–266. https://doi.org/10.1097/00006534-200001000-00043

    Article  CAS  PubMed  Google Scholar 

  21. Sclafani AP, Dibelius G (2015) Transpalpebral midface lift. Facial Plast Surg Clin N Am 23:209–219. https://doi.org/10.1016/j.fsc.2015.01.007

    Article  Google Scholar 

  22. Patrocinio L, Patrocinio T, Patrocinio J (2013) Subperiosteal Midface-Lift. Facial Plast Surg 29:206–213. https://doi.org/10.1055/s-0033-1347000

    Article  CAS  PubMed  Google Scholar 

  23. Moelleken B (1999) The superficial subciliary cheek lift, a technique for rejuvenating the infraorbital region and nasojugal groove: a clinical series of 71 patients. Plast Reconstr Surg 104:1863–1874. https://doi.org/10.1097/00006534-199911000-00043

    Article  CAS  PubMed  Google Scholar 

  24. Saltz R, Ohana B (2012) Thirteen years of experience with the endoscopic midface lift. Aesthet Surg J 32:927–936. https://doi.org/10.1177/1090820X12462714

    Article  PubMed  Google Scholar 

  25. Hamra ST (2016) Building the composite face lift: a personal odyssey. Plast Reconstr Surg 138:85–96. https://doi.org/10.1097/PRS.0000000000002310

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Hamra ST (1992) Composite rhytidectomy. Plast Reconstr Surg 90:1–13. https://doi.org/10.1097/00006534-199207000-00001

    Article  CAS  PubMed  Google Scholar 

  27. Isse NG (1994) Endoscopic facial rejuvenation: endoforehead, the functional lift Case reports. Aesthet dPlast Surg 18:21–29. https://doi.org/10.1007/BF00444243

    Article  CAS  Google Scholar 

  28. Batniji RK, Williams EF (2005) Effects of subperiosteal midfacial elevation via an endoscopic brow-lift incision on lower facial rejuvenation. Facial Plast Surg 21:33–37. https://doi.org/10.1055/s-2005-871761

    Article  CAS  PubMed  Google Scholar 

  29. LaFerriere KA, Castellano RD (2005) Experience with percutaneous suspension of the malar fat pad for midface rejuvenation. Facial Plast Surg Clin N Am 13:393–399. https://doi.org/10.1016/j.fsc.2005.05.002

    Article  Google Scholar 

  30. Keller GS, Namazie A, Blackwell K et al (2002) Elevation of the malar fat pad with a percutaneous technique. Arch Facial Plast Surg 4:20–25. https://doi.org/10.1001/archfaci.4.1.20

    Article  PubMed  Google Scholar 

  31. Ramirez OM (2001) Anchor subperiosteal forehead lift: from open to endoscopic. Plast Reconstr Surg 107:868–871. https://doi.org/10.1097/00006534-200103000-00035

    Article  CAS  PubMed  Google Scholar 

  32. Saltz R (2005) Endoscopic temporal-incision only midface lift is enhanced by endotine technique. Aesthet Surg J 25:80–83. https://doi.org/10.1016/j.asj.2004.12.005

    Article  CAS  PubMed  Google Scholar 

  33. Byrd HS, Burt JD (2002) Achieving aesthetic balance in the brow, eyelids, and midface. Plast Reconstr Surg 110:926–933. https://doi.org/10.1097/00006534-200209010-00032

    Article  PubMed  Google Scholar 

  34. Fiala TG, Owsley JQ (1998) Use of the Mitek fixation device in endoscopic browlifting. Plast Reconstr Surg 101:1700–1703. https://doi.org/10.1097/00006534-199805000-00045

    Article  CAS  PubMed  Google Scholar 

  35. Rohrich RJ, Beran SJ (1997) Evolving fixation methods in endoscopically assisted forehead rejuvenation: controversies and rationale. Plast Reconstr Surg 100:1575–1582. https://doi.org/10.1097/00006534-199711000-00032

    Article  CAS  PubMed  Google Scholar 

  36. Hester TR, Codner MA, McCord CD et al (2000) Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg 105:393–406. https://doi.org/10.1097/00006534-200001000-00063

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. UA Esthetic Clinic, Istanbul, Turkey

    Ufuk Askeroglu

  2. VM Medical Park Florya Hospital, Beşyol, Florya, Akasya Sk. No:4 D:1, 34295 Küçükçekmece, Istanbul, Turkey

    Turgut Kayadibi

  3. Ozgur Pilanci Private Clinic, Istanbul, Turkey

    Ozgur Pilanci

Authors
  1. Ufuk Askeroglu
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  2. Turgut Kayadibi
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  3. Ozgur Pilanci
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Correspondence to Turgut Kayadibi.

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The authors declare that they have no conflicts of interest.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All patients signed an informed consent form.

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Supplementary Information

The endoscopic dissection starting from the temporal zone down to the midface. Anatomical landmarks and dissection planes were tagged in the presentation. Trinity Lift was also demonstrated in both external and endoscopic views (MP4 164130 kb)

Our preferred fixation suture was presented in the video (MP4 29682 kb)

Intraoperative view of Trinity Lift effect was demonstrated in the video (MP4 4097 kb)

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Askeroglu, U., Kayadibi, T. & Pilanci, O. Trinity Lift: A Unique Technique for Endoscopic Midface and Lower Periorbital Unit Lift. Aesth Plast Surg 45, 992–1001 (2021). https://doi.org/10.1007/s00266-021-02126-5

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  • DOI: https://doi.org/10.1007/s00266-021-02126-5

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