MicroAire

The ENDOTINE Midface™ ST 4.5 in Midface Suspension

Background: N.D. Moscoe, MD trained in General Surgery at the Vanderbilt University School of Medicine prior to completing plastic surgery training at the Eastern Virginia School of Medicine. He also completed a Hand and Microsurgery Fellowship at the University of Louisville School of Medicine. He is board certified by the American Society of Plastic Surgeons and is a member of the American Society of Plastic Surgeons, the American Society of Aesthetic Plastic Surgery, and is a Fellow of the American College of Surgeons. He currently directs a thriving cosmetic surgery practice in Austin, Texas. Dr. Moscoe has been using the ENDOTINE Midface for subperiosteal midface suspension since November 2003.
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BEFORE: A 42 year old female (Figure 1) presented with signs of mid-facial aging and concerns that the middle third of her face was drooping. On exam, she was noted to have drooping malar fat pads, a deepened nasolabial fold, and a low eyelid/cheek junction.
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DISCUSSION:The patient is shown at 13 weeks post-operatively (Figure 2). Elevation of the malar fat pad and elevation of the lid/cheek junction is apparent. The depth and shape of the nasolabial fold has been softened also. Additional experience with the ENDOTINE Midface device has revealed that it is minimally palpable six months postoperatively. This patient also under went laser skin resurfacing, fat injection of marionette lines, and a neck lift.
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Dr. Moscoe commented that “because this implant (ENDOTINE Midface) is designed to offer enhanced cheek volume while reducing the complexity of the procedure, I believe that many surgeons will begin to proactively market this as a major part of their facial practice.”
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Operative Technique:*The patient was marked, placed under general anesthesia, and prepped and draped in the supine position. Pre-operative antibiotics (1 gm of kefzol iv) were given. An oblique incision was made in the temporal area 2 cm posterior to the hairline and deep temporal fascia was identified. Under endoscopic visualization, this tissue plane was followed inferiorly to the zygoma. The midface was then entered in a subperiosteal plane. A radial buccal sulcus incision was then made, and the midface dissection was completed under direct vision with the aid of a lighted Aufricht retractor. The ENDOTINE Midface device was inserted through the temporal incision, passed superficial to the zygoma, and advanced to an optimal position overlying the maxillary antrum (Figure 3). The tines were exposed by triggering the insertion tool release mechanism (Figure 4) and the cheek soft tissues were pressed onto the tines (Figure 5). The insertion tools were then removed, and the leash, now extending through the temporal incision, was tensioned (Figure 6) to achieve the desired midface suspension effect. The leash was then sutured to the deep temporal fascia and the temporal and buccal incisions were closed. These steps were carried out on one side at a time.
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* The operative technique described here was employed by N.D. Moscoe, MD for the subject case study and
may vary from other acceptable operative techniques. Please refer to the ENDOTINE Midface Instructions for
Use prior to use.