Understanding midfacial rejuvenation in the 21st century.

Facial rejuvenation has largely focused on surgical procedures of the lower and upper one thirds of the face. Over the past 15 years, research focus on the midface has given aesthetic facial surgeons more tools to improve the signs of aging. The term midface has been used with various definitions, but includes the lower eyelid subunit beginning at the inferior border of the tarsal plate and cheek, down to the nasolabial fold. Many surgical approaches to the midface have been described including skin tightening with direct excision, skin-muscle flaps, fat repositioning, and, our preferred method of endoscopic browlift approach, subperiosteal lifting. We will describe the anatomy and aging of the midface, review surgical and adjunctive techniques, describe our method of the subperiosteal midface-lift including its limitations and risks, and discuss current challenges.