The Selection of Facelift Approach on the Basis of Midfacial Ptosis

Facial aging in the midface has been described to encompass both soft tissue descent and volumetric change. Currently, there is no established and widely accepted grading system for midfacial ptosis. We propose a simplified grading system for midfacial ptosis ranging from mild to severe in terms of Grades I through III. Using this classification system, we describe an algorithm to help select the facelift approach most appropriate for each patient. The sub-superficial musculoaponeurotic system rhytidectomy, deep plane rhytidectomy, and subperiosteal midface lift techniques are described in detail. The nuances of the selection process also include a discussion on the various approaches to the orbital fat, namely a transconjunctival lower lid blepharoplasty with skin pinch versus a lower lid blepharoplasty with fat transposition, as well as the aging neck. Furthermore, we integrate the addition of postoperative adjunctive procedures which include injectables, chemical peels, and dermabrasion to address facial rejuvenation from not only a gravitational aspect but also the volumetric and textural components.

Lower Eyelid Blepharoplasty

The eyelids and periorbital tissues undergo significant changes with aging and often constitute a major concern for those seeking facial rejuvenation. Over the last decade, there has been a steady increase in the demand for lower eyelid rejuvenation. Many techniques and approaches exist to address these concerns, including both noninvasive (filler, lasers, or chemical resurfacing) and invasive (Blepharoplasty or midface lift) procedures. The danger of side effects when performing lower blepharoplasty has kept many patients and physicians away from the surgery, yet advances in lower eyelid blepharoplasty techniques made this procedure more relevant. The exact surgical approach remains controversial and is largely dependent upon surgeon preference and a patient’s cosmetic desire. Here we review the aging changes in the lower lid, indications, preoperative considerations, operative techniques, and complications of lower lid blepharoplasty.