title: The transconjunctival deep-plane midface lift: a 9-year experience working under the muscle.
abstract: BACKGROUND
  Rejuvenation of the midface with a natural-looking, safe, and long-lasting result is a challenge in aesthetic surgery. The ideal approach should be easy to perform, with minimal risk and significant benefit. The combination of transconjunctival exposure and preservation of the periosteum may result in lower morbidity than traditional midface rejuvenation.
  
  
  OBJECTIVE
  The authors present their 9-year experience with the transconjunctival deep-plane midface lift (TDML) and discuss the benefits and limitations of this procedure relative to traditional approaches.
  
  
  METHODS
  A retrospective review (2000-2009) was conducted of 124 consecutive patients treated by the same surgeon (JWF) with the TDML approach. The technique combines transconjunctival and preperiosteal dissection under direct vision. Collected data included patient demographics, operative technique, concomitant procedures, and postoperative results. Complications and revisions were reviewed to assess safety and long-term efficacy.
  
  
  RESULTS
  Patients included 97 women and 27 men, with a minimum of 13 months of postoperative follow-up (median, 56 months). The mean operating time for upper blepharoplasty with TDML was less than 150 minutes. No significant complications occurred. One patient required reexcision of redundant lower eyelid skin, and another patient underwent secondary excision via traditional midface lift.
  
  
  CONCLUSIONS
  The TDML procedure is safe and effective. The technique is readily applicable and more "forgiving" than the traditional midface lift. With proper patient selection, the limited soft-tissue dissection reduces surgical morbidity. Patients with excessive skin redundancy or festoons should be treated with more traditional techniques.
authors.affiliation: Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA.
authors.forename: Iris A
authors.initials: IA
authors.lastname: Seitz
authors.forename: Orlando
authors.initials: O
authors.lastname: Llorente
authors.forename: Julius W
authors.initials: JW
authors.lastname: Few
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000009:adverse effects; D002641:Chicago; D004210:Dissection / Q000009:adverse effects; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012060:Rejuvenation; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome