title: Periorbital skeletal augmentation to improve blepharoplasty and midfacial results.
abstract: BACKGROUND
  Narrow palpebral fissures, short lower lids, and full cheeks are hallmarks of youthful periorbita. The presence of these features is predicated on a convex upper midface skeleton. Faces whose midface skeletons are flat or concave do not manifest these youthful attributes, tend to age prematurely, and are prone to lower lid malposition after blepharoplasty.
  
  
  METHODS
  Augmentation of the infraorbital rim with alloplastic implants can provide convexity to the deficient upper midface skeleton. Suspension of the cheek soft tissues (subperiosteal midface lift) on this now supportive framework narrows the palpebral fissure, shortens the lower lid, and gives fullness to the cheek. The addition of lateral canthopexy to skeletal augmentation and subperiosteal midface lift can restore lower lid position when previous blepharoplasty has resulted in lower lid malposition in patients with deficient midface skeletons.
  
  
  RESULTS
  This concept has been utilized in 87 patients (65 female, 22 male) over the last 7 years. Of these 87 patients, four patients (5 percent) required revision surgery to correct implant malposition or prominence. Three patients (3 percent) required implant removal to treat infection. Implants were later replaced in two of these three patients.
  
  
  CONCLUSIONS
  Augmentation of the infraorbital rim with alloplastic implants provides convexity to the upper midface skeleton. Together with lower lid and midface soft-tissue suspension, it creates or restores youthful periorbital aesthetics.
authors: Boston, Mass., and Palo Alto, Calif. From the Division of Plastic Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, and Division of Plastic Surgery, Department of Surgery, Stanford School of Medicine.
authors: Michael J
authors: MJ
authors: Yaremchuk
authors: David M
authors: DM
authors: Kahn
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D015331:Cohort Studies; D004954:Esthetics; D005147:Facial Bones / Q000503:physiopathology / Q000601:surgery; D005149:Facial Expression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009915:Orbit / Q000503:physiopathology / Q000601:surgery*; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult