Preoperative Planning and Drawings

The "M" point ("M" for malar cheek) is located at the crossing point between a vertical line drawn across the lateral canthus and a horizontal line passing through the inferior border of the nostril (ala nasi) (Fig. 45.5). To understand the significance of the "M" point, we should observe the facial modifications associated with a forced smile. When smiling, the shortening of the comical expression muscles between their attachment points projects all tissues in front of the malar bone. It produces a youthful unbroken roundness from the nasogenial sulcus to the zygo-matic arch and masks the orbital border. This position is associated with a natural shortening of the lower eyelid. The "M" point will be used to insert the percutaneous suspension of the malar cheek.

The subciliary approach is drawn as the classic lower-eyelid approach with an external extension in an oblique wrinkle at the outer corner of the eye. This extension must not be longer than 1 cm for discretion purposes. It will be used to resorb the lower-eyelid skin excess after orbicular stretching and malar cheek

Fig. 45.1. Subciliary and temporal incisions

elevation. The deep approach can also be performed through the outer aspect of the upper-eyelid incision.

The temporal approach is performed through a 3 cm horizontal line drawn 3 cm behind the temporal hairline implantation (Fig. 45.1).

Fig. 45.2. Malar subperiosteal detachment through the lower-eyelid approach

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