gms | German Medical Science

44. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen e. V. (DGPRÄC), 18. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen e. V. (VDÄPC)

12.09. - 14.09.2013, Münster

High vertical subperiosteal midfacelift: Transcutaneous versus transoral suspension sutures

Meeting Abstract

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  • presenting/speaker Johannes Franz Hoenig - Paracelsus Klinik Hannover, Plastische Chirurgie, Hannover, Deutschland
  • Daniel Knutti - Paracelsus Klinik, Plastische Chirurgie, Hannover, Deutschland
  • Frank Michael Hasse - Paracelsus Klinik, Plastische Chirurgie, Hannover, Deutschland

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und ─sthetischen Chirurgen. Vereinigung der Deutschen ─sthetisch-Plastischen Chirurgen. 44. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und ─sthetischen Chirurgen (DGPR─C), 17. Jahrestagung der Vereinigung der Deutschen ─sthetisch-Plastischen Chirurgen (VD─PC). MŘnster, 12.-14.09.2013. DŘsseldorf: German Medical Science GMS Publishing House; 2013. DocFV 03

doi: 10.3205/13dgpraec011, urn:nbn:de:0183-13dgpraec0113

Published: September 10, 2013

© 2013 Hoenig et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: With age the soft tissue of the face tends to follow the forces of gravity more vertically rather than oblique. The cheeks begin to look saggy or flat, lower eyelids enlarges can become puffy or hollow and circles begin to appear under the eyes. This encourages performing an upper high midface lift in a more vertical direction from an temporal approach. Usually tissue fixation is accomplished by a series of sutures position for greater aesthetic control of cheek tissue elevation using a transoral or a transcutaneous approach.

Material and method: Using this technique to provide a natural and improved facial rejuvenation of the upper midface and the lower lid we analysed the suspension suture techniques via transcutaneous versus intra an oral approach on 58 female patients with a mean age of 44,8 +/- 8,3 years. We compare operation time, durability, complications and post op swelling. 31 patients were treated via a transcutaneous procedure and 27 females via a transoral approach.

Results: The results confirmed that vertical upper high midface lifts in patients with an intraoral approach have less post operative swelling that tends to disappear faster, probably due to some drainage intraoraly approach. The operation time was 20 +/- 7 min minutes shorter in average using the transcutaneous suspension suture method. Using the transoral approach we found in 3 cases a partial wound dehiscence (10%) but no infection. In transcutaneous approaches we saw in 3 cases small dimples, (10%) but not detected and corrected intraoperatively.

Discussion: Both vertical midface suspension techniques are simple and allow adjustments of tension and position for greater aesthetic control of cheek elevation and projection. They give volume enhancement and projection of the midface tissue. Therefore the high vertical subperiosteal midface lift is an effective and safe procedure via an intra oral as well as a transcutaneous approach. This introduced procedure is an exciting feature that has evolved into a very useful modality. It gives natural and improved facial rejuvenation

Conclusion: In case of extreme sagging of the midface and marked nasolabial folds the intraoral approach assures sufficient subperiosteal mobilisation and gives the possibility to easily distribute the weight of the elevated soft tissues over 2 or 3 cheek suspension sutures. This technique tends to give better long lasting results in selected cases. In indicated cases we prefer the transcutaneous approach as standard procedure for simplicity and shorter operation time. However the transoral approach has certain advantages in selected cases, as shown.