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The preperiosteal midcheek lift technique

Called a pre-periosteal midcheek lift, this technique involves the precise release of the retaining ligaments that separate midcheek soft-tissue spaces. This approach is non-traumatic and, therefore, has little downtime, according to the study.

From November 2009 to June 2014, authors Chin-Ho Wong, M.D., of Mount Elizabeth Medical Center, Singapore, and Bryan Mendelson, M.D., Melbourne, Australia, performed the midcheek lift procedure on 184 patients. According to the study, they used a transcutaneous lower eyelid blepharoplasty incision to access the pre-septal space:

  • Medially, the orbicularis oculi origins and tear-trough ligament are released sharply, connecting the dissection with the premaxillary space.
  • More laterally, the orbicularis retaining ligament is released, connecting the dissection with the prezygomatic space. With this release, the entire mid-cheek can be effectively lifted.

The fat pads were managed by transposition, excision or with septal resets as indicated. Canthopexy was performed routinely to provide lower eyelid support. Superolateral traction on the orbicularis oculi elevates the entire mid-cheek, and this is secured to the lateral orbital rim periosteum. Structural fat grafting can be done in cases where patients experience significant volume loss in the mid-cheek.

Releated: Factoring face shape into surgical facial rejuvenation

The authors write that all patients demonstrated a significant rejuvenation of the mid-cheek with elimination of the eye bags, elevation of the lid-cheek junction and the cheek prominence, and improvement of the nasolabial folds. According to the study, nearly all patients (96%) were satisfied with the procedure. Complication rates were low: Ectropion and lower-lid retraction had a 1% occurrence.

“The midcheek lift by means of the facial soft-tissue spaces is safe, effective and long-lasting,” the authors write. “As the dissection is atraumatic, recovery is quick and complications are minimized.”

The study appears in the December issue of Plastic and Reconstructive Surgery.

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