Midfacial rejuvenation

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.