The Transblepharoplasty Subperiosteal Midface Lift: A 13-Year Review

Purpose: To present a reliable technique for midface rejuvenation and to review the associated short- and long-term outcomes. The technique seeks to restore youthful volume to the midface by employing a subperiosteal release of the cheek, four-point bony suspension along the orbital rim, and post-septal fat redraping.

Methods: This is a retrospective review of a single surgeon's subperiosteal midface lifts between 1998 and 2011, and includes 137 patients (average age = 53 ± 24). Standardized medical records and pre- and post-operative photographs were reviewed for demographics, co-morbidities, concomitant procedures, complications and outcomes.

Results: Complications were divided into short-term (lasting less than 6 weeks) and long-term (lasting greater than 6 weeks or requiring re-operation).  The most common short-term post-operative sequelae were chemosis (38%), transient scleral show (21%), and lagopthalmos (8%).  Long-term complications included hematoma requiring evacuation (0.7%), persistent scleral show deemed non-operative (0.7%), and lateral scar webbing requiring minor revision (0.7%).

Conclusions: The described technique optimizes control of the suspension vector for the midface subunit, provides stable fixation to the orbital rim, and does so without requiring alteration to the lateral canthus. It represents an effective means for rejuvenating the lower eyelids and cheek while maintaining a low long-term complication rate.¹

Figure 1: Pre-operative photo illustrates lid-cheek concavity, tear troughs, and lower lid fat pseudoherniation. Figure 2: Post-operative photo with blunting of tear trough, and youthful lid-cheek convexity.  Note that due to the aggressive lower lid skin resection the left lower lid nevus seen pre-operatively rests in the post-operative lateral ciliary margin.