The subperiosteal, drill hole, midface lift

This article describes a surgical technique using drill holes through the inferior orbital rim and fixation with permanent sutures as a functional subperiosteal midface lift and compares it to other standard midface elevation techniques. This was a retrospective, comparative, non-randomized study. Charts of all patients undergoing midface elevation between 2009 and 2013 were reviewed. Pre- and post-operative photos were graded on a scale 0 to 3 with 0 representing normal lower lid position and lid/cheek junction and 3 representing the most severe malposition. Twenty-seven patients (35 sides) underwent midface lift. Twelve sides had the subperiosteal drill hole midface lift; 9 preperiosteal with Vicryl suture fixation to periosteum; 14 subperiosteal with Endotine midface B device. All groups had similar demographics and indications for surgery. Average follow-up time was greater than 4 months in all groups. No significant complications were seen in any of the patients. The average post-operative grade of the drill hole group was 0.65 compared to 0.75 of the preperiosteal Vicryl group and 0.7 of the Endotine group. The drill hole group had the most severe pre-operative malposition. Overall, the drill hole group demonstrated the largest improvement score. The subperiosteal drill hole technique proved to be an effective method for functional midface elevation. This technique achieves adequate and durable vertical elevation without relying on the strength of the periosteum or use of a commercial device.