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Original Investigation
October 17, 2019

Investigation of the Longevity of the Endoscopic Midface Lift

Author Affiliations
  • 1Lewis Katz School of Medicine, Department of Otolaryngology–Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania
  • 2Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 3Lewis Katz School of Medicine, Department of Clinical Sciences, Temple University, Philadelphia, Pennsylvania
  • 4Department of Ophthalmology, Assaf Harofeh Medical Center, Be'er Ya'akov, Israel
  • 5Facial Plastic and Reconstructive Surgery, Aurora, Illinois
  • 6Scheie Eye Institute, Perelman School of Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia
JAMA Facial Plast Surg. 2019;21(6):535-541. doi:10.1001/jamafacial.2019.1015
Key Points

Question  Is the endoscopic preperiosteal midface lift an effective technique, and do the results last?

Findings  In this retrospective review, there was a significant, objective improvement (decrease) in midfacial height after the endoscopic preperiosteal midface lift that persisted for at least 5 years and up to 15 years. Validated regional and global aesthetic scales demonstrated lasting improvement in midface appearance over time.

Meaning  There is a persistent improvement in midfacial height after the endoscopic preperiosteal midface lift that is achieved without complete disruption of the midfacial ligaments.

Abstract

Importance  To our knowledge, until now, the efficacy and durability of the transtemporal endoscopic preperiosteal midface lift has not been reported in the literature.

Objective  To determine the efficacy and longevity of the endoscopic preperiosteal midface lift using objective measurements and validated aesthetic scales.

Design, Setting, and Participants  This retrospective review included patients 18 years or older who were treated for aging midface by endoscopic midface lift by the senior author (A.E.W.) between June 2000 and August 2016. Patients were categorized based on length of follow-up into 3 groups: (1) short-term (1-3 years), (2) intermediate-term (3-5 years), and (3) long-term (>5 years).

Interventions or Exposures  Endoscopic preperiosteal midface lift.

Main Outcomes and Measures  (1) Objective measurements of midfacial height (the width of the interzygomatic distance of the midface to the medial canthus [WIZDOM-MC]), (2) validated regional aesthetic scales, and (3) global aesthetic scoring systems measured preoperatively, 3 to 6 months postoperatively, and at the most recent follow-up visit.

Results  Adult patients 18 years or older (median [range] age, 59 [31-79] years) who were treated for aging midface by undergoing an endoscopic midface lift were included in this study. The medical records of 143 patients were reviewed (135 women and 8 men). The endoscopic midface lift resulted in objective improvement in midfacial height. The median WIZDOM-MC decreased by 3.4 mm after the endoscopic midface lift (interquartile range [IQR], 2.3-4.4 mm; P < .001), thus shortening the elongated lower eyelid. At 5 to 15 years after surgery, there was a sustained decrease in median WIZDOM-MC of 2.1 mm (IQR, 0.8-3.1 mm; P < .001). Improvement in the infraorbital hollow was also sustained in patients at more than 5 years’ follow-up (IQR, 0-1.0; P < .001). Improvements in upper cheek fullness and lower cheek fullness were maintained at 3 to 5 years and tended to be at baseline at more than 5 years. Global aesthetic improvement scores remained significantly improved at 5 to 15 years’ follow-up.

Conclusions and Relevance  There is a significant, objective improvement in midfacial height after the endoscopic midface lift that persists for up to 15 years. Validated midfacial scales and global aesthetic scoring systems demonstrate sustained improvement in midface appearance over time. Surgery that minimally disrupts the zygomatic and orbicularis retaining ligaments can provide long-lasting aesthetic improvements.

Level of Evidence  4.

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