Overview
With age, the bone, muscle, fat and skin of the face change in volume, shape, position and consistency, and lose their balance. From clinical cases and fresh cadaver dissections, the authors developed a rhytidectomy that releases all soft tissue from the bone of the orbit, upper maxilla, cheekbone and nose. The released tissues can then be lifted back into a youthful relationship with the skeleton.
Findings
- Subperiosteal release of soft tissue from the orbit, upper maxilla, malar bone and nose.
- Areas lifted: cheek, forehead, jowls, nasolabial folds, outer eye corner and eyebrows.
- 105 patients over 4 years.
- 60% had surgery in hospital under general anesthesia.
- 40% had outpatient surgery with local anesthesia (lidocaine 1% with epinephrine) and intravenous sedation (midazolam, ketamine).
- Complications were minimal except temporary paralysis of the frontal nerve in 7 patients.
- Guidelines to prevent frontal nerve injury were developed afterward.
- The authors describe results as "excellent" and "more natural" for the upper and central face, brows, eye area, outer eye corner, cheeks and nasolabial fold.
What it means for a patient
- A subperiosteal facelift works at the level of the bone, lifting all the soft tissue above it together.
- The authors describe it as suited to the upper and central face, brows, eye area and cheeks.
- In this series, 7 of 105 patients had temporary weakness of the forehead from nerve injury.
- Results are the authors' own description. The abstract gives no measured outcomes or length of follow-up.
Why this paper matters
It described the subperiosteal facelift, which releases facial soft tissue at the level of the bone. It reported the frontal nerve as the main risk and led the authors to develop prevention guidelines. Cited 141 times (NIH iCite, 2026-09-25).
Terms
- Subperiosteal: beneath the periosteum, the thin tissue covering bone.
- Rhytidectomy: the medical name for a facelift.
- Malar bone: the cheekbone.
- Maxilla: the upper jawbone.
- Frontal nerve (frontal branch): the facial nerve branch that raises the eyebrow and forehead.
- Lateral canthus: the outer corner of the eye.
- SMAS: the layer of muscle and fibrous tissue under the facial skin and fat.
- Intravenous sedation: calming drugs given through a vein during surgery.