Arcus marginalis release II via endoscopic midface-lift.

Tear troughs in combination with midfacial ptosis may be early and synergistic signs of aging. Premaxillary and suborbicularis oculi fat (SOOF) descent decreases soft tissue volume covering the orbital rim, while prolapsing retroseptal fat actually underscores the resulting tear trough shadow. This volume change precedes skin redundancy.

Arcus marginalis release in blepharoplasty I: technical facilitation.

Resection of intraorbital fat compartments in lower-lid blepharoplasty has been widely replaced by their realignment over the orbital rim. For older patients this usually includes an open subciliary approach with skin resection and orbicularis muscle modification. In younger patients this may be done transconjunctivally.

The concentric malar lift: malar and lower eyelid rejuvenation.

Midface rejuvenation surgery is most challenging. The margin of error for the lower lid is on the order of 0.5 mm, and the cosmetic result can sometimes look unnatural.

Combined arcus marginalis release, preseptal orbicularis muscle sling, and SOOF plication for midfacial rejuvenation.

Improvements have been made throughout the history of medicine, causing physicians to abandon a technique or medications clearly shown to be suboptimal. Unfortunately, this has not happened with rejuvenative surgery. Conventional lower eyelid procedures continue to include removal of orbital fat in most cases, and facelift procedures remain primarily a lateral vector pull.