Volumetric Perceptions in Midfacial Aging with Altered Priorities for Rejuvenation

The history of facial rejuvenation surgery has largely involved the manipulation of facial soft tissues under tension within the two-dimensional confinements of a facial plane. However, the youthful human face is not planar; it presents as a complex geometric solid with a curvilinear profile on the oblique view that forms an architectural ogee. Restoration of this shape by sculptural manipulation of the facial soft tissues is deemed the highest priority in midfacial rejuvenation, whereas improvement of the periorbital and perioral environments is deemed second. Effacement of the nasolabial fold is relegated to a third level of importance in this philosophy of altered priorities for midfacial rejuvenation. The importance of early patient photographs is stressed in operative planning to direct facial changes toward a past intrinsic facial personality. Postoperative results are presented of patients who have undergone facial rejuvenation by a new midfacial technique that targets these reordered goals. Comparisons with photographs taken earlier in life and traditional preoperative photographs can then be made. (Plast. Reconstr. Surg. 105: 252, 2000.)