Pitfalls of Midface Surgery

The endoscopic forehead midface lift is perhaps the most powerful tool that has been made available to the facial aesthetic surgeon in the last 10 years. Because of their central location, changes that occur in the midface, such as a hollowed orbit/ double contour, visible orbital rim, deepened nasolabial folds, and mandibular jowls can contribute significantly to the drawn, aged look of a patient. The ability to lift the malar fat pad and restore it to its earlier position can partially reverse these stigmata and do more to restore a patient’s youthful character than many other interventions [Figs. 1 and 2]. Although the endoscopic forehead midface lift can reap the greatest rewards, it is also the operation fraught with the greatest peril. A difficult dissection, prolonged period of edema, and numerous other pitfalls have tempered enthusiasm among facial aesthetic surgeons for this powerful technique. In our practice, with experience performing over 800 of these procedures, the midface lift can be performed both safely and effectively. Through careful analysis of the pitfalls of midface surgery, one can adopt principles that help prevent or minimize potential complications. Suchanapproachcanmaximize the surgical benefit to the patient and lessen the anxiety surrounding the procedure for the patient and surgeon alike.