A simplified approach to midface aging.

We review herein our experience with subperiosteal midface-lifting under direct vision with a simple fixation technique. The technical aspects of the procedure are described in detail. A total of 121 patients underwent midface-lifting and meloplication with the 82/18 L-lactide/glycolide device (Coapt Endotine Midface ST 4.5; Coapt Technologies, Palo Alto, Calif) by both the senior (G.S.K.) and junior (R.N.H.) authors. The senior author's experience included 110 patients over a 26-month period. Thirty-two of these cases were isolated procedures. The other 78 were performed in conjunction with various procedures, most commonly rhytidectomy. There were no revisions during this period. Two cases of "puckering" were noted. Both were immediately corrected, one with fat injection and one with poly-L-lactic acid injection (Sculptra; Dermik Aesthetics, distributed by Besse Medical Supply, West Chester, Ohio). The junior author's experience included 11 cases over an 8-month period. Two cases of asymmetry were noted. One was corrected with fat injection, and the other required revision. Subperiosteal midface-lifting and meloplication using the Coapt Endotine Midface ST 4.5 device is a simple, effective technique that can be quickly learned and applied.