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Critical Evaluation of a 5-Year Experience

Edwin F. Williams III, MD; Hannah Vargas, MD; Ravinder Dahiya, MD; Christopher R. Hove, MD; Bret J. Rodgers, MD; Samuel M. Lam, MD

Arch Facial Plast Surg. 2003;5:470-478.

Objective  To evaluate the surgical technique, cosmetic results, and complications of patients who underwent a midface-lift via a minimal-incision brow-lift performed by the senior author (E.F.W.).

Setting  Private, ambulatory surgical center.

Design  A retrospective review of 325 midface-lifts performed over a 5-year period by a single surgeon.

Patients  A total of 325 consecutive patients who underwent a midface-lift, with or without concurrent rhytidectomy and other adjunctive procedures, and who completed 3 months of follow-up were reviewed for perioperative complications. One hundred patients who had complete photographic and chart records and who had a minimum of 6 months of follow-up were randomly selected for photographic rating and chart review. Of the patients who had a minimum of 1 year of follow-up, 50 were randomly selected to determine if midfacial elevation led to any evidence of lateral-canthal distortion.

Main Outcome Measures  Midfacial elevation was assessed in 3 facial zones by 3 independent evaluators. Zone I represents the malar-infraorbital complex; zone II, the nasolabial sulcus; and zone III, the jawline. The zones were rated on a scale from 0 to 2 (0, no improvement; 1, mild improvement; and 2, marked improvement). Change in the lateral-canthal position was measured in the vertical and horizontal axis for each eye. All complications were recorded.

Results  The 3 independent evaluators correlated well in their scores ( = 0.643) and found that most patients showed the best improvements in zone I, with 70% of patients showing marked improvement (P<.001). Moderate improvement was noted in zone III (marked improvement, 30%; mild improvement, 50%; and no improvement, 20%). Little or no improvement was noted in zone II (marked improvement, 4%; mild improvement, 60%; and no improvement, 36%). Patients who underwent a rhytidectomy along with a midface-lift showed better elevation in zone III. However, patients who underwent a brow/midface-lift alone also showed favorable improvement along the jawline (zone III). Although the postoperative lateral-canthal position revealed statistically significant vertical elevation of the lateral canthus on the right side, this finding did not correlate with any perceived clinical significance by the reviewer or patient (P<.01). Temporary morbidity included 2 subperiosteal abscesses and 3 frontal and 1 buccal facial nerve neuropraxias that resolved by 6 months. Permanent complications included 1 case of unilateral cranial nerve V₂ paresthesia. Five patients had alopecia requiring scar revision. Many of these complications, including subperiosteal abscess and alopecia, have subsequently been avoided by minor technique modifications.

Conclusion  The technique of midface-lift via transbrow approach is a safe, reliable method of midfacial rejuvenation and avoids the unnatural lateral-canthal distortion previously described in the literature.

From the Division of Otolaryngology, Department of Surgery, Albany Medical College, and the Williams Center for Facial Plastic Surgery, Albany, NY (Drs Williams, Vargas, and Dahiya); the Section of Facial Plastic and Reconstructive Surgery, Otolaryngology Division, Stanford University, Stanford, Calif (Dr Hove); the Rodgers Center for Facial Plastic Surgery, Boise, Idaho (Dr Rodgers); and the Lam Facial Plastic Surgery Center, Dallas, Tex (Dr Lam).

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