Malar Cheek and Orbicular Suspensions

We first begin with the malar cheek suspension and we use a kind of Hagedorn needle specially described by Besins for this procedure. The "M" point (Fig. 45.5) is used to insert the percutaneous suspension of the malar cheek (Fig. 45.6). The needle is inserted straight into the bone pinching the ptotic malar fat pad toward the outer corner of the eye incision, where the 2 Vicryl or Dexon threads are introduced. A roundtrip movement allows a thick grip without any dimples. The thread is carried to the temporal incision under the temporal skin (Fig. 45.7).

The orbicular stretching is made with a 1 Vicryl thread, introduced into the lower malar orbicular muscle under the lateral canthus. A vertical testing tension on the thread must correct any scleral show without any lateral detachment of the lower-eyelid rim. A more superficial 3/0 Vicryl thread is sometimes passed on the orbicular muscle flap to secure the grip. The threads are carried under the temporal incision. We perform a double or triple suspension.

All threads are sutured to the temporal fascia with high tension (Fig. 45.8). Sometimes, threads can be fixed to the frontal bone using tunnels sunk through the external cortical bone or Endotine fixation devices.

Sum Lift Ergebnis
Fig. 45.4. Temporal deep fascia and subperiosteal orbitomalar detachment junction
Fig. 45.5. The "M" point

Fig. 45.6. Malar cheek percutaneous suspension

Fig. 45.7. The thread is carried to the temporal incision under the temporal skin

Fig. 45.8. Result after complete unilateral suspension. Note the lower-eyelid skin excess

Fig. 45.7. The thread is carried to the temporal incision under the temporal skin

Fig. 45.9. Early result. Provisional temporal wave

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