Atlanta - Combining a midfacelift in patients undergoing blepharoplasty is an efficient, minimally invasive method to provide long-lasting, stable results in individuals who do not require a full facelift.

"This procedure is designed for patients with early signs of midface aging to improve the appearance of the eyelids and the midface by creating a more youthful, anatomic transition between the lower eyelid and the cheek," said Mark A. Codner, M.D., a plastic surgeon specializing in oculoplastic surgery.

The modified approach results in a quicker recovery and less prolonged edema than that caused by a full, subperiosteal dissection, he explained.

"We have been doing midface elevation through the lower blepharoplasty for five years, and the results are good, predictable, and stable over time," he said.

The different degrees of aging can be classified according to different morphological signs of aging. The earliest stage is excessive puffiness in the lower eyelids with no change in the projection of the cheek and no change in the midface, said Dr. Codner, assistant clinical professor, plastic surgery, Emory University School of Medicine, Atlanta.

Moderate signs of aging, in addition to lid puffiness, include descent of the SOOF (suborbicularis oculi fat) and the malar fat pad. Hollowing and irregular contours become apparent from the lower lid to the cheek.

Advanced signs of aging include more significant loss of cheek projection due to malar pad descent, as well as the development of malar bags and the nasojugal tear trough deformity.

"The hollowness seen in the midface is caused by the loss of tissue which camouflages the inferior-orbital rim," he explained.

A standard blepharoplasty with fat removal has its limits in that once fat is removed, a hollow appearance may be accentuated. In a modified lower blepharoplasty cheeklift, the fat from the cheek is preserved and raised, and the fat from the lower lid is selectively transposed and sutured over the inferior-orbital rim or removed in a conservative fashion, Dr. Codner said.

"In addition to being an excellent primary aesthetic procedure, this is also a corrective procedure following previous traditional lower blepharoplasty," he added.

Five to 10 years postoperative, patients who have fat removed may develop a hollow orbital rim appearance with descent of the midface. This procedure is useful to correct fat over-resection from previous blepharoplasty, and/or elevate the midface, which was not previously addressed with standard techniques, he offered.

"The modified midface will soften the upper portion of the nasolabial folds but is not a procedure aimed at improving the nasolabial fold," he cautioned. "This is really an extension of the lower blepharoplasty for younger patients who may not need a facelift."

He said it softens the lid and cheek, and it can be combined with less invasive endoscopic techniques to address the moderately aging neck. "This means patients in their 40's will have no telltale scars; the scars are hidden in lower blepharoplasty or posterior auricular region."

The technique described by Dr. Codner's group, Paces Plastic Surgery, is a modification of the subperiosteal cheeklift (a procedure designed for more advanced facial aging). In their technique, a modified cheeklift is performed above the periosteum and through a transcutaneous lower blepharoplasty incision to improve the appearance of the lower lids and cheek.