Abstract
Background
Early aging changes of the periorbital-midface unit frequently present as lateral brow descent, lid-cheek elongation, and early midface ptosis. Conventional facelift procedures may be unnecessarily invasive in such patients, while isolated brow-lifting techniques often fail to adequately address the functional continuity of the periorbital-midface complex.Objectives
This study introduces the endoscopic periorbital and midface rejuvenation with direct fixation technique, which is designed to achieve stable repositioning of the periorbital-midface unit through anatomically guided mobilization and direct periosteal fixation.Methods
The technique includes a transtemporal incision and dissection under endoscopic visualization, sequential release of temporal ligamentous structures, entry into the prezygomatic space, vertical mobilization, direct fixation of the malar fat pad to the periosteum of the lateral orbital rim and temporal lifting using barbed sutures. Objective outcomes were assessed using standardized photographic measurements, and patient-reported outcomes were evaluated using FACE-Q domains.Results
The study included 62 patients with a mean follow-up of 15.2 months. Significant improvements were observed in brow height (mean increase 18.3%), lateral canthal angle (8.4%), and lower eyelid length (mean reduction 19.7%) (p Conclusions
Endoscopic periorbital and midface rejuvenation with direct fixation provides effective improvement of the brow-periorbital-midface complex with a favorable safety profile.Level of evidence iv
Therapeutic study. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.