Anatomic and aesthetic considerations in midfacial rejuvenation

An early sign of the aging process involves changes to the midface. The loss of the lid-cheek continuum begins with underlying laxity in the orbitomalar ligament. As the face continues to age, the malar pad drops inferomedially in position. The approach to the midface has evolved over the past 15 years with the advent of endoscopically assisted techniques of midfacial elevation. Further technology, such as thread-lifting procedures and the Endotine Midfacetrade mark, have supplemented the choices for surgical correction of this facial segment. Descriptions of the different approaches to the aging midface are reviewed.