Transconjunctival Midface Lift: A "Hole" Different Fixation

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. Result: 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. Conclusion: 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.