Many midface rejuvenation patients don’t have ideal bone structure to support commonly used procedures, and as a result, they can end up dissatisfied with the results.

But a new study suggests accurate diagnosis and avoidance of certain anatomic pitfalls are the keys to successful midface rejuvenation and enhanced patient satisfaction. The new study, which appears in JAMA Facial Plastic Surgery, also offers an easy-to-follow algorithm to help surgeons match the correct approach or approaches with the right patient.

Andrew A. Jacono, MD, of North Shore University Hospital, Manhasset, NY, and colleagues performed a retrospective review of 150 patients who underwent surgical midface rejuvenation procedures by a single surgeon. The outcome was assessed via patient satisfaction at the 1-year mark. Patients had an average age of 51 years, and were 93.3% women. Fourteen percent of them were unsatisfied, the study showed.jacono

Surgeon Beware: Anatomical Pitfalls and Midface Rejuvenation

According to the article, many patients lack the ideal bone structure for common cheek rejuvenation procedures. Now, a simple technique using intersecting lines can easily determine if a patient’s facial structure will easily allow for optimal results from certain cheek procedures.

Jacono explains: “Tuck a pencil over the top of your ear, keeping it perfectly horizontal. Then, place your index finger vertically against your forehead to form an intersection. Where these two intersect is where your cheekbone should fall, if you’re a prime candidate for basic cheek rejuvenation procedures.”

 And if they are not, the study introduces an algorithm for determining the most successful cheek rejuvenation procedures for the patient based on a myriad of specific anatomic and genetic considerations. Puffer Fish DSC01257

 “Aging of the cheeks is complex and multifactorial, and so cosmetic consultation for rejuvenation is thus the most difficult,” he says. “This algorithm, organized into a simple flowchart that aesthetic surgeons may consult, will assist in selecting a plan with patients that has the highest likelihood of success because it affords a customized and integrated approach specific to each patient’s facial structure, “ he says.

“All of these techniques can be effective in the right patients, and a lot of times surgeons get married to a particular technique, but when performed in the wrong patient, it is ineffective,” he says in an interview with Plastic Surgery Practice. “You have to have some way of discussing preoperatively what predicts sufficient outcomes.”

For example, if a patient shows a significant loss of facial elasticity, volumization alone won’t work. “The face fills up, and the patient looks like a bloated puffer fish,” he says. In this scenario, the surgeon should tighten the skin before injecting any fat or fillers.

“If you do have a patient who does not have a more classic skeletal structure, they have higher failure rates, so a multifactorial approach will produce a more significant result,” he says. Often, a combination of procedures is required to help build cheek volume. For example, an endoscopic mid-face or mini-S type facelift can be combined with fat transfers or cheek augmentation, he says.