Trans-inferior orbital rim anchorage and fascia roll multi-loop temporal anchorage in midface rejuvenation.

Abstract

A paradigm promoted for midface rejuvenation by Besins in his reverse and repositioning effect (RARE) technique considers 3 vertical sectors of the face. It relies on thread-based suspensions of the malar area and the orbicularis oculi with long cable suture forehead anchoring. The author reports on the use of short cable suture anchorage points as an alternative suspension method that helps to avoid and/or correct asymmetry and ectropion. An oblique malar elevation with short cable suture transorbital anchoring, in conjunction with a Hester-Flowers orbicularis oculi transzygoma anchoring technique, was performed using a new technique for fascia roll, multi-loop temporal anchoring and auricular tightening. A series of 295 patients have undergone the procedure since Spring 2002, with follow-up of up to 31 months. A strong oblique malar elevation, focused on nasolabial fold correction, eyebrow elevation, and better jaw definition, along with a natural appearance of the face were found to be stable over time. Transorbital anchoring allows strong malar elevation and lower lid support for rejuvenation and correction of complications. It should be combined with a Hester-Flowers orbicularis oculi transzygoma anchoring technique and can be performed in conjunction with a fascia roll, multi-loop temporal lift, submental fat and partial submaxillary gland removal, and auricular tightening as part of a full face lift procedure.