Personal experiences and algorithm of endoscopically assisted subperiosteal face lift in orientals for 5 years

Orientals are anatomically distinct from Caucasians and are characterized b y a thick dermis, a Mongoloid slant of the palpebral fissure, a relatively prominent zygoma and mandible angle, and a relatively flat nose. Given thes e characteristics, it was believed that the subperiosteal face lift was not suitable for Orientals. However, at our institution, endoscopically assist ed subperiosteal face lifts were performed from May of 1994 to October of 1 998 on 236 patients; variable pitfalls, as well as satisfying results, were reported. Patient ages ranged from 29 to 66 years (mean age, 55.2 years), and follow-up ranged from 6 to 44 months (mean follow-up, 23 months). All f orehead and brow lifts were performed using an endoscopic guide, and routin e corrugator resections and procerus myotomies were performed. Three slante d cortical tunnels were made at the corresponding locations on the outer ta ble of the calvarium, and 1-0 nylon or screw suspension and fixation were p erformed after a 1-cm to 2-cm lift. Midface lifts were performed through lo wer blepharoplasty incisions and vertical temporal incisions instead of thr ough conventional preauricular and postauricular incisions. Dissections wer e made subperiosteally and over the deep layers of deep temporal fascia. Ma lar fat pads were suspended with 1-0 nylon and affixed to deep temporal fas cia. Most patients have been satisfied with their postoperative results, but unf avorable results and complications have been reported. Complications were c lassified as early or late complications or unfavorable results on the basi s of the 3-week postoperative evaluation, There were 28 early complications (11.9 percent), consisting of ecchymosis with edema (persisting for up to 4 weeks), paresthesia, lagophthalmos, accentuated Mongoloid slant. small di mpling on the scalp, and scalp fold formation on the fixation site. There w ere 13 late complications/unfavorable results (5.5 percent), consisting of insufficient lift, exaggeration of sunken upper eyelids, intermittent heada ches, itching sensations, and paresthesia on the scalp. The unfavorable res ults occurred in the patients who had previously undergone blepharoplasty a nd in those who had a history of foreign body injections into the face, fat ty and thick faces, sunken upper eyelids, Mongoloid slants, and asymmetric facial expressions. Through understanding the anatomic characteristics of t he Oriental face (i.e., thick dermis, Mongoloid slant of palpebral fissure, prominent zygoma and mandible angle, and flat nose), satisfying results we re achieved by appropriate application of the modified procedures.