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Rejuvenation of the Upper
Face and Midface: Current
Techniques

BRENT MOELLEKEN, MD, FACS
AGING UPPER THIRD OF THE FACE
TRENDS
CHOICE OF BROW REJUVENATION TECHNIQUES
RELEVANT ANATOMY

Features of the Aging Brow
Features of the Aging Periorbital Region
Brow Position Aesthetics
Lateral Canthus

TREATMENT OF THE HAIRLINE

Correction of the High Anterior Hairline
Correction of Temporal Hair Loss
Direction of Incision in Hairline
Ear Incisions

FOREHEAD AND BROW LIFTS

Direct Minimally Invasive Brow Lift Rejuvenation
Procedures
Muscle Division Techniques
Nerve Ablation Techniques
Single-Stitch Techniques
Coronal Brow Lift
Upper Eyelid Blepharochalasis
Male Brow Surgery
Endoscopic Brow Lift

 

AGING UPPER THIRD OF
THE FACE

As surgeons who rejuvenate the face, our goals are simple: reverse as many of the signs of aging and do as little harm as possible in the process.A plastic surgeon cannot return the full, undamaged nature of youthful skin (Table 47-1). One can only focally reverse the atrophy that occurs with age. The successful surgeon will have a variety of techniques to customize a surgical plan for a patient and keep the goals and limitations of facial rejuvenation in perspective.

Many features of aging, such as midfacial aging, orbicularis drooping, brow ptosis with thinning hairlines, and fat and periorbital fat atrophy, can now be addressed. Essential treatments include composite grafting for hollow regions, fat preservation in periorbital surgery, and lower eyelid and midfacial

 

Temporal Lift
Brow Lowering Techniques
Botulinum Toxin
Laser Resurfacing

MIDFACIAL AGING

Arcus Marginalis Release
Malar Fat Pad Elevation
Redraping the Orbicularis Arc
Cervicofacial Hike Procedure
Subperiosteal Face Lift Techniques
Combined Subperiosteal Techniques
Composite Face Lift Technique
Midface Lifts for Avoidance of Lateral Sweep
Syndrome
Postblepharoplasty Sequelae in Facial Rejuvenation
Crow’s-Feet
Midface Suborbicularis Technique
Superficial Cheek Lift Technique
Limitations in Midfacial Tissue Elevation
Subperiosteal Subciliary Procedures
Endoscopic Midface Techniques
Asian Face Lifts
Skeletal Augmentation to Achieve Rejuvenation
(Cheek or Composite Implants)
Fat Injection and Grafting


rejuvenation. Through skin care and lighter interventions, such as peels and resurfacing with various lasers, it is possible to improve and restore the quality of skin and reduce fine rhytids and sun damage. In vulnerable patients, customized brow lifts avoid hairline disturbances while addressing many of the signs of aging.Botulinum toxin focally addresses rhytids that formerly required invasive surgeries or surgeries that imperfectly or at great price rejuvenated these areas.
Yet unsolved are problems of aging skin surfaces and fat atrophy, specifically facial and periorbital fat atrophy; atrophy of the temporal fat pad, buccal fat pad, and malar fat pad; and global fat atrophy in the subcutaneous tissue. New understanding of anatomy has caused a renaissance in rejuvenation of the upper face and midface. The understanding of the relationship between the midface and the remainder of the face is still evolving.