Transtemporal midface lifting to blend the lower eyelid-cheek junction.

When examining the results of this technique, improvement is noticed in the infraorbital hollowing, midface tissue ptosis, depth of nasolabial folds, and degree of jowling. The greatest overall improvement is the extent of midface ptosis and infraorbital hollowing at the lower eyelid-cheek junction followed by improvement in the nasolabial region. Improvement in jowling was common but less significant than the improvement of the midface structures. The authors think that this dramatic improvement is owing to multiple factors. With wide and complete release of the central and lateral midfacial structures, the en bloc suspension of the SOOF and malar fat pad is thoroughly accomplished. Unlike other midfacial techniques, the transtemporal midface achieves pull in 2 vectors, directing the repositioning of tissuesboth superiorly and laterally. The superior vector repositions the SOOF and malar fat pad over the bony infraorbital rim and malar/zygomatic complex, whereas the lateral pull effaces the nasolabialfold. This superior vector more accurately reverses the forces of aging displayed on the ptotic midface. Lastly, although this technique is not designed primarily to eliminate jowling at the mandible, it has been noted that elevation of 1.0 to 1.5 cm of skin overlying the mandible is typical. Although the endoscopic forehead midface lift is not without its complications or pitfalls, all of these can be minimized, easily managed, or avoided completely through the intraoperative techniques and postoperative care. Careful and deliberate preoperative counseling of patients regarding the possible bumps in the road to recovery is critical. By using the techniques available to limit and manage complications and setting appropriate patient expectations should these complications occur, the endoscopic forehead midface lift can become an extremely powerful and safe technique in the facial cosmetic surgeon’s armamentarium to efface the lid-cheek junction with a high degree of patient satisfaction.