Understanding the finger-assisted malar elevation technique in face lift

Background: The finger-assisted malar elevation technique addressing the midface represents one of the new trends in surgical techniques for facial rejuvenation. Although Aston described it in 1996, until now there has been no detailed publication on this technique and its anatomical relations. This study focused on the anatomical structures and layers involved in it. Methods: Ten cadavers were dissected from the orbicularis oculi muscle to the base of malar fat pad, which was detached. All visible anatomical structures were described. The finger-assisted malar elevation technique was used in clinical cases and the surgical technique was described. Results: This digital maneuver is performed in a relatively avascular plane, over the muscles and underneath the malar fat pad. The safety of this technique is also reinforced by the absence of important anatomical structures. Two hundred fifty-three patients underwent this procedure, and minor complications were recorded in six patients. Conclusions: The supra-superficial musculoaponeurotic system plane is a safe and natural plane for the finger-assisted malar elevation technique. It also carries the advantage of allowing greater mobilization of the nasolabial fold, the superficial musculoaponeurotic system, and excess skin, although the major advantage is the facility of repositioning the malar fat pad to its original position, over the zygomatic body prominence.