A youthful appearance is marked by prominent cheeks and soft-although present-nasolabial folds that show obtuse angles between the folds and the alae nasi. This picture serves, in part as a mental template toward wich we strive when performing rejuvenation surgery. The aging midface, in contrast, is marked by an acute angle between the fold and the ala and a deep sulcus of the nasolabial fold. This area of the midface has, arguably, been the most difficult are to treat with many methods employed to correct the deepening sulcus.6,7
Hamra´s deep-plane facelift technique, described a technique (which he had used for more than 6 years) that was minimally invasive and held promise for softening the fold and addressing the desdent of the malar fat pad. The technique described circumvented the moe extensive dissection required in a deep-plane his data in August 2002 with Cohen as coauthor.5 The procedure, called the percutaneous cable-suture technique for midface rejuvenation, could be used in combination with rhydectomy or, as a primary procedure in the younger patient, for correction of the earliest sign of midface aging: the prominent nasolabial fold.
Building on a good concept, Keller1further modified the procedure by burying the suspension pledget within the malar pad, using only one polytef pledget and creating a distinct temporal pocket within which the suspension suture is secured.Burying the pledget is done by creating a short tract in the malar pad, which then allows the surgeon to bury the polytef pledget within the malar mound. Creating the stab incisions lateral to the nasolabial fold itself also serves to eliminate the pucker seen here in other described techniques. Short-term results with the percutaneous cheek lift are promising. One of the authors (RWHK) has visited Keller, who shared his technique, wich both authors have succesfully attempted.
