Periorbital and midfacial rejuvenation via blepharoplasty and sub-periosteal midface rhytidectomy.

The stigmata of midfacial ageing are the malar descent, lateral orbital festoon formation, tear-through deformity, deep melojugal sulcus, buccal fat pad and sub-orbicularis oculi fat (SOOF) prolapse, deep nasolabial folds and cutaneous and muscular descent. The signs of periorbital ageing include dermatochalasis, skin hooding of the upper eyelids, lacrimal gland prolapse, adipose prolapse, and lateral canthal descent and orbital septum diastasis. All of these deformities can be addressed through upper and lower blepharoplasties with arcus marginalis release, lateral canthopexy, sub-periosteal midface rhytidectomy with temporal suspension of the malar mound and SOOF repositioning. The same technique can be utilized for the restoration of facial symmetry after Bell's palsy. In the following report the technique and the authors' experience in the rejuvenation of the periorbital and midface region are presented. There were a total of 20 patients in this series. Sixteen were female and 4 were male. All the patients were followed-up on a monthly basis after surgery for the first 6 months. They were then seen at 1 year post-surgery. All of the patients were evaluated by the senior author. In the beginning of the study there was 1 Asian female patient with mild postoperative ectropion, which resolved and did not require operative intervention. The patients experienced prolonged postoperative oedema. The patients were satisfied with their postoperative outcomes. In all patients, the goals of periorbital and midfacial rejuvenation were achieved with the above technique. Simultaneous periorbital and midfacial rejuvenation can be achieved via upper and lower blepharoplasties, lateral canthopexies and sub-periosteal midface rhytidectomy.