Transblepharoplasty Endoscopic Subperiosteal Midface Lift

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Transblepharoplasty Endoscopic Subperiosteal Midface Lift
– John V. Williams, M.D.

use of endoscopy in the transblepharoplasty midface lift is essential
for preventing the complications of facial nerve injury and bleeding.
Complete observation allows precise dissection and release of all
structures in the composite flap. This technique fully preserves the
zygo-orbicular nerve plexus and prevents denervation of the orbicularis
oculi and zygomaticus muscles. Blind dissection has a significant
probability of denervation of the entire zygo-orbital muscle complex,
and avulsion of the zygomaticofacial vessels, with associated postoperative
bleeding complications. The modification involving suturing of the
“vest” of the combined lateral orbital periosteal and superficial
layers of the deep temporal fascia over the elevated “pants”
of the orbicularis periosteal flap provides very secure fixation for
suspension of the lower eyelid and midface. The use of slowly absorbable
polydioxanone sutures for this technique prevents the problems caused
by permanent sutures beneath the very thin skin of the lateral canthal
area. Careful trimming of the prominent roll of the orbicularis muscle
that often develops with suspension eliminates the uneven contour
and yields a smooth lower lid appearance. The details and modifications
described should decrease the complications and morbidity that can
occur with this procedure and provide for a more precise and reliable
procedure for rejuvenation of the lower eyelid and midface.

Baton Rouge, La.

From the Aesthetic
Surgery Center.

Received for publication
December 18, 2001;
revised March 29, 2002.

John V. Williams,

The Aesthetic
Surgery Center

8777 Bluebonnet

Baton Rouge, La.

[email protected]

Plastic and Reconstructive
Surgery 2002; 110(7):1769-1775
Copyright © 2002 Lippincott Williams & Wilkins
All rights reserved

The endoscopic
subperiosteal midface lift was previously presented by Ramirez 1 and
Isse 2 and then by Hester et al. 3, 4 This procedure requires precise
surgical dissection and attention to detail, to obtain good results
without complications. This area is very unforgiving regarding even
small errors in technique. Complications in the lower lid and lateral
canthal areas are often very difficult to correct. This article describes
and illustrates the anatomical importance of the use of the endoscope
in performing the transblepharoplasty subperiosteal midface lift, which
has not been previously reported. Several technical modifications of
this procedure, which should help improve the consistency of results
and minimize the incidence of complications, are presented.


The lateral canthal skin incision is made in the natural skin crease
of the lateral canthal area, at or slightly above the level of the
lateral orbital canthus. It extends laterally for a distance of approximately
1.25 cm. The skin incision is extended only slightly medially along<