Midcheek Lift Using Facial Soft-Tissue Spaces of the Midcheek.

BACKGROUND This article describes a preperiosteal midcheek lift technique performed by means of the midcheek soft-tissue spaces by precise release of the retaining ligaments that separate the spaces. METHODS From November of 2009 to June of 2014, 184 patients underwent this procedure. A transcutaneous lower eyelid blepharoplasty incision was used to access the preseptal space. Medially, the orbicularis oculi origins and tear trough ligament are released sharply, connecting the dissection with the premaxillary space. More laterally, the orbicularis retaining ligament is released, connecting the dissection with the prezygomatic space. With this release, the entire midcheek can be effectively lifted. The fat pads were managed by transposition, excision, or with septal resets as indicated. Canthopexy is performed routinely to provide lower eyelid support. Superolateral traction on the orbicularis oculi elevates the entire midcheek, and this was secured to the lateral orbital rim periosteum. In patients with significant volume loss in the midcheek, structural fat grafting is performed. RESULTS All patients demonstrated a significant rejuvenation of the midcheek with elimination of the eye bags and elevation of the lid-cheek junction and the cheek prominence and improvement of the nasolabial folds. The majority of the patients (96 percent) were satisfied with the procedure. Complication rates were low. Ectropion occurred in 1 percent of patients, and lower lid retraction occurred in 1 percent of patients. CONCLUSION The midcheek lift by means of the facial soft-tissue spaces is safe, effective, and long lasting. As the dissection is atraumatic, recovery is quick and complications are minimized.