Three Dimensional Midface Rejuvenation

Concise Purpose

Many facial rejuvenative procedures   tighten tissue which can flatten elastic soft tissue projection and in some patients create the stigma of surgical alteration. Recent trends toward “shadow filling” places injectable volume into the concavity of attenuated ligamental support without transfer of volume from dependent unsupported tissues. These strategies can create an unnaturally shaped face. Cheek augmentation, however, can help in some cases in obtaining the natural Ogee curve of youth and happiness. We seek to identify those facial features  which , when present, increase the difficulty in achieving a natural and successful facelift and would benefit from augmentation.

Methods and Materials

A midface shell was modified  to fit individual facial skeletal requirements. . A silicone template transferred facial dimensions to the porous polyethylene implant which was carved and bent as needed prior to subperiostal insertion via a subciliary incision .Repositioned and lifted  soft tissues were sutured to the screw lag implant fixation..

Experience

Fifty consecutive patients in whom cheek implantation was used in concert with peri-orbital rejuvenation are presented. The procedures were analyzed as to indication, technique, results, and complications. At one year the results were analyzed by a panel of surgeons. One implant was modified by shave under local anesthesia due to asymmetry of lateral projection. No implants were removed: there were no infections, hematomas, long term sensory or motor nerve disfunction, or eyelid malposition.

Summary of Results

By retrospective analysis review we  defined four indications for the procedure. The most common is  pre-existing horizontal maxillary-zygomatic  retrusion with shallow orbit unmasked by  age induced soft tissue descent of the cheek. The second group presented with normal facial skeletal  growth but suffered from severe attenuation of soft tissues due to age, muscle wasting, and in one case Parry-Romberg Syndome lipoatrophy. The third group of patients were altered by aggressive surgical stretch procedures and injudicious use of facial liposuction. The last group consisted of  males who all initially recognized their turkey neck as an indication for surgery but became aware of  hemiexopthalmos creating an aged appearance. An algorithm is presented identify and treat each group.

Conclusions

 This study shows that  midface augmentation  improves  outcomes in properly selected patients with identifyable preoperative facial shape patterns.