Midface lift of the malar fat pad: technical advances

Most of the advances of the past decade in face lift technique have been directed to correcting the aging changes of the midface. With many midface lift techniques, patients typically experienced a prolonged period of periorbital ecchymosis and edema. Pessa's description of the anatomy of the malar septum has led to modifications of the senior author's (J.Q.O.) malar fat pad lift technique, designed to minimize postoperative ecchymosis and edema following mobilization of the malar fat pad. Preoperatively, markings of the cutaneous insertion of the malar septum are placed at the infraorbital location. This line approximates the caudal margin of the musculus orbicularis oculi. Dissection under the malar fat pad is performed sharply under direct visualization. Care is taken to stay caudal to the malar septum insertion as marked on the skin. Refinements in the dissection of the midface malar fat pad have not altered the effective repositioning achieved. By leaving the malar septum intact, the amount of postoperative edema and ecchymosis is less than formerly associated with the dissection over the infraorbital orbicularis. With rare exception, patients were able to resume their usual activities and employment after a recovery period of 10 to 21 days postoperatively.