title: Minimal Undermining Suspension Technique (MUST): Combined Eyebrow and Mid-face Lift via Temporal Access.
abstract: BACKGROUND
  Less downtime following esthetic interventions leads to the popularity of injectable solutions for facial rejuvenation treatments. Surgical interventions for esthetic purposes are usually associated with higher complication rates and longer recovery times when compared to less invasive treatments. Here we present for the first time a minimally invasive surgical technique for a simultaneous mid-face and eyebrow lift using one small temporal incision.
  
  
  METHODS
  We prospectively studied patients who underwent facial rejuvenation using a minimal undermining suspension technique (MUST) in an outpatient setting. Postoperatively, surgical complications were classified according to the Clavien-Dindo classification. Preoperatively and at 12-month post-intervention, patient-reported outcomes were described using the FACE-Q questionnaire. Pre- and postoperative pictures were compared using MERZ Aesthetic Scales.
  
  
  RESULTS
  Fifty-five patients (50 females and 5 males) with a mean age of 47 years were studied. The overall complication rate was 19%, whereas 18 patients (15%) developed an ecchymosis of the orbicular temporal region and two patients (4%) developed a dimple caused by the anchor of the suture. No displacements of the palpebral rim or injuries to the facial nerve were observed. Recovery time was in average 7 days and no long-term complications were seen. Both, the FACE-Q and the MERZ Aesthetic Scales showed significant improvements at 12-month post-surgery (p < 0.01).
  
  
  CONCLUSIONS
  The MUST can be used as a minimal invasive procedure for facial rejuvenation with a short downtime and low complication rate. The discreet temporal access and the MUST dissector allowed a safe dissection of anatomical tissue planes to perform safely a mid-face and eyebrow lift. Further studies are warranted to prove long-term outcomes.
  
  
  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 A3 online Instructions to Authors. www.springer.com/00266 .
authors.affiliation: Dental School, Vita-Salute San Raffaele University, Via Olgettina Milano 58, 20132, Milan, Italy.|Surgical Medical Group, Piazzale Biancamano 2/2, 20121, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gualdi
authors.affiliation: Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria. j.cambiaso.daniel@gmail.com.
authors.forename: Janos
authors.identifier: http://orcid.org/0000-0003-2022-352X
authors.initials: J
authors.lastname: Cambiaso-Daniel
authors.affiliation: Surgical Medical Group, Piazzale Biancamano 2/2, 20121, Milan, Italy.
authors.forename: Jonatann
authors.initials: J
authors.lastname: Gatti
authors.affiliation: Division of Dental and Maxillofacial Surgery, Department of Surgery, Medical University of Verona, Piazzale Luduvico Antonio Scuro 10, 37134, Verona, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Bertossi
authors.affiliation: Global Plastic and Reconstructive Surgery, Nyon, Switzerland.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pietramaggiori
authors.affiliation: Global Plastic and Reconstructive Surgery, Nyon, Switzerland.
authors.forename: Saja S
authors.initials: SS
authors.lastname: Scherer
authors.affiliation: Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
authors.forename: Paul
authors.initials: P
authors.lastname: Wurzer
authors.affiliation: Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
authors.forename: David B
authors.initials: DB
authors.lastname: Lumenta
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods; D016208:Databases, Factual; D004954:Esthetics; D005138:Eyebrows; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D060052:Nasolabial Fold / Q000601:surgery*; D011446:Prospective Studies; D012060:Rejuvenation; D015361:Rhytidoplasty / Q000379:methods*; D015595:Skin Aging; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D013701:Temporal Bone; D016896:Treatment Outcome
keywords: Clavien–Dindo classification; Combined lift; Eyebrow lift; FACE-Q; MERZ Aesthetic Scales; Mid-face lift