Subperiosteal rejuvenation of the midface and periorbital area: a simplified approach.

A simplified approach to subperiosteal midface rejuvenation is presented. The technique was developed through experience with 60 subperiosteal face lifts over an 8-year period. Because it does not involve a lower eyelid incision, there is no risk of ectropion, yet the midfacial structures and orbicularis oculi muscle can be elevated easily and precisely. The procedure can be performed alone but is more commonly performed in conjunction with brow lift and traditional SMAS dissection of the lower face and neck. The benefits of this subperiosteal approach to the midface are powerful elevation of the midfacial structures, improvement of the nasolabial folds, enhancement of the cheek prominences, smoothing of the nasojugal folds, and tightening of the orbicularis oculi. The procedure is performed through small incisions in the temple and gingival sulcus. The operation is technically straightforward and poses little risk to neurovascular structures. Concerns over prolonged swelling have not materialized. There have been no instances of lower lid or canthal abnormalities.