Aesthetic Recontouring of the Midfacial Skeleton: A Regional Approach

Abstract

Aesthetic facial skeleton recontouring, whether done for traumatic, congenital, or aesthetic indications, is gaining in popularity. In the past, its success has largely depended upon the aesthetic sense of the surgeon. Through the use of cadaver dissections, the underlying bony anatomy of the midface was studied and subsequently divided into three distinct regions. The contribution of each of these regions of the midface to the oblique and frontal profiles is described. With utilization of moulages taken from the surface of skulls in these regions, anatomically contoured implants were designed. To facilitate clinical implant placement and symmetry, skin markings employing superficial landmarks of the face are described. The standard blepharoplasty incision for subperiosteal placement of the regional implants is detailed, and the benefits of this technique over previously described routes of insertion are discussed. A total of 73 malarplasties in 35 patients have been performed in a period of more than 4 years. Surgery is easily done under local anesthesia either alone or in conjunction with rhinoplasty, blepharoplasty, or rhytidectomy.