Overview
The subperiosteal face lift described by Psillakis was criticized for not improving much on conventional brow and face lifts, and for a high rate of nerve injury. The authors report anatomic findings and surgical changes meant to make the operation safer and its results better, used in 28 patients.
Findings
- Extensive, interconnected subperiosteal dissection including the entire zygomatic arch.
- This repositions the deep soft tissues of the whole upper face, most of the midface and, indirectly, key structures of the lower face.
- The upward pull of the cheek and mouth muscles raises the corner of the mouth, affecting the smile, oral frowning and the jowls.
- Dissection deep to both layers of the temporal fascia lowers the risk of injury to the frontalis nerve.
- The temporal fascia is used to lift and anchor the cheek and mouth-area tissues, instead of the fibrofatty tissue around the eye, lowering risk to the frontal and zygomatic nerve branches.
- 28 patients with the modified technique: high satisfaction, no nerve injuries.
- Initial 60 patients (Psillakis or Tessier approach): nerve injury rates of 11 and 20 percent.
What it means for a patient
- A subperiosteal face lift works at the bone surface and lifts the deep tissues of the upper face and midface.
- Nerve injury was a real risk with earlier versions. These changes aimed to avoid the nerve branches to the forehead and eye.
- Limits: 28 patients, satisfaction described only as "high," no follow-up length in the abstract, and comparison with the authors' earlier patients rather than a controlled trial.
Why this paper matters
It reported changes to the subperiosteal face lift that, in the authors' series, cut nerve injury from 11 and 20 percent to none, and extended the dissection across the zygomatic arch to reach the midface. Cited 124 times (NIH iCite, 2026-09-25).
Terms
- Subperiosteal: beneath the periosteum, the thin tissue layer that covers bone.
- Zygomatic arch: the bony bar of the cheekbone that runs toward the ear.
- Temporal fascia: the tough tissue layers covering the muscle at the temple.
- Facial nerve: the nerve that moves the muscles of facial expression.
- Frontalis nerve: the facial nerve branch to the forehead muscle.
- Jowls: sagging tissue along the jawline beside the chin.
- Psillakis and Tessier approaches: earlier subperiosteal face lift methods named after the surgeons who described them.