Endoscopic Midface Rejuvenation through the Temporal Approach

ABSTRACT

We approach the midface endoscopically through a 3 to 4 cm temporal incision. The dissection is multiplanar: it involves a subgaleal approach to the forehead, a subfascial approach to the temporal region, a subperiosteal approach along the zygomatic arch, and preperiosteal approach around the orbital rim and zygomatic body. The zygomatic cutaneous ligament is released over the origin of the zygomaticus major muscle. The malar/orbicularis complex is then free to be resuspended along a vertical vector. This is accomplished by suturing the mobilized free edge of the zygomatic cutaneous ligament to the lateral orbital rim and temporalis fascia. Redundancy in the temporal skin flap is eliminated by galeal anchorage to the temporalis muscle fascia along a superolateral vector of traction without scalp excision. Excess lower lid fat is removed through a transconjunctival approach preserving the integrity of the orbicularis muscle. Fat injection, when needed, is performed to the tear through and submalar area.

Keywords

Endoscopic - midface lift - temporal approach - retaining ligament