title: Transconjunctival midface lift: a "hole" different fixation.
abstract: BACKGROUND
  Improvements in midfacial rejuvenation have allowed for more predictable and reliable results; however, there are still common problems that can lead to a suboptimal outcome. Specifically, we aim to achieve an appropriate vector of lift, adequate camouflaging of the nasojugal groove, especially medially, as well as to obtain a durable, long-term result.
  
  
  OBJECTIVE
  We aim to demonstrate that utilizing bony fixation to obtain midface lift will allow for better control of vector placement as well as lead to a more durable result and, thus, a better long-term outcome.
  
  
  METHODS
  We reviewed our series of 12 cases using a new technique of transconjunctival midface lifting alone or in combination with a standard facelift to correct the issues of midface descent and the tear trough deformity. By utilizing a suture technique using bony fixation, we present a technique that addresses all of the above issues while providing a durable, long-term result.
  
  
  RESULTS
  The result in all cases was rated good to excellent with no eyelid malposition, ectropion, or relapse at the 12-month follow-up visit. The advantages of the technique include (1) achieving a full vertical vector of soft tissue elevation, (2) smoothing the concave lid-cheek junction with local tissue, and (3) durable suspension by utilizing bony fixation.
  
  
  CONCLUSIONS
  The transconjunctival midface lift is a powerful tool in the armamentarium of the facial aesthetic surgeon. Through a simple innovation utilizing bony fixation, a more durable result can be obtained.
authors.affiliation: Methodist Hospital, Weill Cornell Medical School, Houston, Texas, USA. mikeeisemann@gmail.com
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Correa
authors.forename: Bradley
authors.initials: B
authors.lastname: Eisemann
authors.forename: Michael
authors.initials: M
authors.lastname: Eisemann
mesh_terms: D000328:Adult; D002610:Cheek / Q000601:surgery; D005004:Ethmoid Bone / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009915:Orbit / Q000601:surgery; D012060:Rejuvenation; D015361:Rhytidoplasty / Q000379:methods*; D013536:Suture Techniques