Subperiosteal and Endoscopic Surgery

Concepts in facial rejuvenation over the past five years have changed dramatically. In the past, all that was considered was a face-lift. As time went on, eyelid surgery and brow elevation became part of the standard surgical treatment. Over the past five years, we have learned that we no longer want to just address the laxity of the soft tissues and the wrinkling with a face- lift and removal of eyelid fat and skin. Now we look at the entire facial complex from the skin all of the way down to the facial skeleton. This includes the outer and inner layers of the skin, the fatty tissue, the underlying dynamic muscles of facial expression along with the facial bone structure and the tissues that hold everything to the facial skeleton. Each of these tissues needs to be analyzed and the patient's individual anatomic abnormalities evaluated and considered for treatment.

In looking at the facial skeleton as the framework for your image, over the past several years we have been able to evaluate, manipulate and improve the bony soft tissue interface. Subperiosteal surgery identifies and separates the overlying soft tissues at the lowest possible level. With this separation, the soft tissues can be further resuspended into a higher and more youthful position. This can be a significant advantage for certain patients. A careful individual consultation and analysis and surgical plan may utilize this treatment option.

Frequently to get to this location of the facial skeleton, endoscopic techniques can be utilized. The most common area for its use is in the forehead and brow region. Endoscopic techniques at the brow region allow the brows to be repositioned in a more youthful shape and location. In addition, it allows us to weaken the muscles of the forehead and brow to further diminish wrinkling from the overactive muscles.

The endoscopic technique can be further extended down along the lateral rim of the eye to the cheekbone region. This allows an additional level of surgery to further reposition the tissues that have migrated with age. Endoscopic techniques allow us to do surgery through small incisions and still achieve excellent surgical results.

In each of the endoscopic techniques (forehead and brows along with midfacial region), the procedure is performed under intravenous sedation and local anesthesia. Usually three to five, 1/2 inch incisions are made, in order to allow both visualization with a small scope and to surgically manipulate the tissues with small, narrow instruments. When the tissues have been released and repositioned, they need fixation. In the forehead region, I usually utilize small screws that are placed into the outer layers of the skull to allow for firm fixation. In a midfacial procedure, deep fascia in the temple region allows for adequate fixation of the tissues.

This technique is one example of some of the technological advances that have occurred in cosmetic surgery. I hope that this information is helpful to you in understanding this procedure. I would be happy to provide you with an individual and confidential consultation to determine if this procedure is right for you.