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The Subperiosteal Mid-Face Lift Using Bioabsorbable Implants for Fixation

  • David E. E. Holck
  • Jill A. Foster
  • Kevin A. Kalwerisky
  • Manuel A. Lopez

Abstract

In recent years, the mid-face has received significant attention in the management of lower eyelid and facial reconstruction as well as rejuvenation. The transtemporal subperiosteal approach descriptions by Ramirez provide excellent vertical lift to mid-face soft tissue and allows redraping or volume redistribution without aggressive preperiosteal soft tissue dissection.1,2 This approach may be continued as an extension of an endoscopic or open browlift procedure as well as combined with lower third facial rhytidectomy surgery to optimize entire facial rejuvenation (facial harmony).3 This technique also allows for fat graft injection, orbital fat pedicle repositioning, malar augmentation, and/or lateral retinacular suspension of the lower eyelid if desired, in a safe fashion. Using a resorbable midface elevation device on a leash allows predictable reliable midface elevation with improved surgical efficiency (Figure 86.1).
Figure 86.1

The Endotine Midface ST bioabsorbable implant (Coapt Systems, Inc. Palo Alto, CA) has a 4.5-mm-length five-point tine to fix the mid-face soft tissue envelope through a subperiosteal approach. The implant has an 11.5-cm leash with fixation holes that allows fixation to the deep temporalis fascia. Shown alongside is the introducer with a rounded hub to prevent soft tissue capture of the tines before adequate positioning.

Keywords

Deep Temporalis Fascia Bioabsorbable Implant Facial Harmony Midface Lift Gingivobuccal Sulcus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Ramirez OM. The subperiosteal rhytidectomy: The third generation facelift. Ann Plast Surg 1992;28:218.CrossRefPubMedGoogle Scholar
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    Ramirez OM. Three-dimensional endoscopic midface enhancement: A personal quest for the ideal cheek rejuvenation. Plast Reconstr Surg 2002;109(1):329–340.CrossRefPubMedGoogle Scholar
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    Little JW. Discussion: three dimensional endoscopic midface enhancement: a personal quest for the ideal cheek rejuvenation. Plast Reconstr Surg 2002;109(1):341–343.CrossRefGoogle Scholar
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    Holck DEE, Robertson OB. Expert commentary, the midface lift. In: Joseph Mauriello (ed.). Techniques of Cosmetic Eyelid Surgery: A Case Study Approach. Philadelphia: Lipppincott, Williams & Wilkins, 2004:173–179.Google Scholar
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    Hamra ST. Prevention and correction of the “face-lifted” appearance. Fac Plast Surg 2000;16(3):215–230.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • David E. E. Holck
    • 1
    • 2
  • Jill A. Foster
    • 3
  • Kevin A. Kalwerisky
    • 4
  • Manuel A. Lopez
    • 5
  1. 1.Department of OphthalmologyThe University of Texas at San Antonio, Health Sciences CenterSan AntonioUSA
  2. 2.Wilford Hall Medical Center, Department of OphthalmologyOculofacial Plastics and Orbital ServiceSan AntonioUSA
  3. 3.The Eye Center of Columbus, Department of OphthalmologyThe Ohio State UniversityColumbusUSA
  4. 4.Health Sciences Center, Wilford Hall Medical Center, Department of OphthalmologyOculofacial Plastic Surgery, The University of Texas at San AntonioSan AntonioUSA
  5. 5.Health Sciences Center, Wilford Hall Medical Center, Department of OtolaryngologyFacial Plastics Service, The University of Texas at San AntonioSan AntonioUSA

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