title: Persistent improvement in lower eyelid-cheek contour after a transtemporal midface lift.
abstract: BACKGROUND
  This study aimed to assess quantitative changes in lower-eyelid aesthetics after a transtemporal midface lift concomitant with transconjunctival blepharoplasty and lower-eyelid skin pinch.
  
  
  METHODS
  The study enrolled 55 consecutive patients who underwent a transtemporal midface lift and concurrent transconjunctival blepharoplasty with lower-eyelid skin pinch. All the surgeries were performed over a 2-year period by the senior author (A.A.J.). Patient demographics and surgical details were recorded. Standardized digital photographs were taken at baseline and then 12 months postoperatively. These were analyzed to assess changes in the vertical height of the lower eyelid and compared using within-subject analysis.
  
  
  RESULTS
  The study cohort consisted of 50 women with a mean age of 54 years (range, 28-76 years). Five patients were lost to follow-up evaluation. The mean vertical height of the lower eyelid was 11.8 mm preoperatively and 9.3 mm postoperatively, giving an average difference of 2.5 mm at the 12-month follow-up assessment. The changes in lower-eyelid height were statistically significant (p = 0.0002), and the lower eyelid-cheek contour was improved in all cases. No major complications occurred during the study period, and no revision surgery was performed. Lower-eyelid height changes did not vary significantly with patient age.
  
  
  CONCLUSIONS
  Age-related changes to the midface are marked by increased vertical height of the lower eyelid and a concomitant appearance of infraorbital hollowing. Separation of the lower eyelid-cheek complex causes the typical double-contour deformity. To the authors' knowledge, no study to date has reported the long-term effect of a midface lift on lower-eyelid aesthetics. The transtemporal midface lift not only repositions the malar fat pad but importantly also provides significant shortening of the lower eyelid at 12 months. This results in an improved midface contour.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA. evan.ransom@gmail.com
authors.forename: Evan R
authors.initials: ER
authors.lastname: Ransom
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Stong
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Jacono
mesh_terms: D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods; D002610:Cheek; D005143:Eyelids; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015361:Rhytidoplasty