Surgery for Midfacial Rejuvenation

Like all other areas of aesthetic surgery, the central one third of the face can be improved by employing a myriad of different procedures. The plastic surgery literature is flush with numerous well-thought-out techniques for attempting to rejuvenate the midface. The particular type of procedure to be employed, or even whether to perform any midfacial procedure at all, ultimately depends on many variables. First among these is whether or not the surgeon perceives the effects of midface lifting to be beneficial and appropriate for their practice population. Some feel the published “successful” results do not look all that different from those of traditional lifting techniques. To others the results look unnatural, with changes occurring around the eyes that alter the patient's appearance. For many there are concerns over a lengthy postoperative recovery time in a competitive atmosphere that rewards “quick fixes” and “minimal downtime” over potentially long-lasting, harmonious results. These opinions and the fact that a majority of patients seem content with results from traditional facelifts may dissuade practitioners from adopting these new procedures. After all, it is ultimately the perception of the patient that determines the success of an operation. However, for those surgeons who have grown uneasy about evaluating their own long-term facelift results, let alone those of other well-intentioned surgeons, changes must be instituted. The familiar combination of hollow skeletonized eyes, tightly pulled skin, and a deformity resembling the Nike “swoosh” emanating from the oral commissure is all too common and will ultimately discourage future patients from undergoing surgery.

The current procedures for manipulating the central face are not the final solution to these problems, but they are a step in the evolution of holistic facial rejuvenation. Because there are so many factors that determine a successful outcome, it is unlikely that a single method will evolve that works for all surgeons on all patients. This does not mean that we should stop developing new techniques in the quest for such a “single best method.” On the contrary, it is only from the efforts and honest critical analysis of our own results and that of our peers that progress will be made and enhanced results will continue. Even now it is evident that the concepts pioneered by a few surgeons for midfacial rejuvenation have compelled us all to rethink the previously accepted ideas about facial aging in general.

Rather than attempt to define one singular way of performing a “midface lift” perhaps we should learn about the indications, effectiveness, and downsides of the various alternatives to apply the appropriate procedures on the appropriate patients. This issue of Facial Plastic Surgery brings together several different surgical techniques that are all oriented toward providing an improved midfacial rejuvenation. I am honored that recognized leaders in the disciplines of facial plastic surgery as well as plastic surgery have offered to share their experiences. All of their methods warrant study and consideration. It is efforts and innovations such as those of these authors that will forge the way for future excellence.