Midface Lift after Zygoma Reduction

Q: Dr. Eppley, my surgeon had indeed mentioned the possibility of performing my midface lift with a more vertical vector through a combined intraoral and transconjunctival eyelid approach. He did not suggest the transcuteaneous approach due to my young age and the aesthetic scar trade-offs.

What are your thoughts on the transconjunctival eyelid and intraoral approach to midface lifting? 

I rejected this method as I was worried about the risk of ectropion.

I am very happy with my zygoma reduction from a bony standpoint but I really cannot live with the results of the soft tissue.

With the scarred tissues from my zygoma reduction and my intraoral/temporal lift, would my tissues be too scarred and atrophied to attempt a more vertical vectored lift?

Thank you again for your insight.

A:The transconjunctival approach does offer a more vertical midface lift but I would have concerns that the limited access through the inner eyelid and the ability to fix the tissues well to the bone would limit the result as well. Another option that provides a stronger vertical cheeklift is the cranial-based approach coming down from way above, avoiding eyelid incisions at all, and suspending the tissues through a small scalp incision to the bone. (combined with an intraoral approach to place the sutures to the cheek tissues.

Dr. Barry Eppley

Indianapolis, Indiana