METHOD FOR TOTAL CASCADE SUBPERIOSTEAL LIFTING OF MID-FACE Russian patent published in 2025 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to plastic surgery. Subciliary approach is formed at 1 cm from a ciliary border of the lower eyelid; an orbicular muscle of eye is dissected along the border of pretarsal and preseptal portions along the fibres with an arched incision from a projection line of the medial edge of the limb to a projection line of the lateral orbital edge. Musculocutaneous flap is mobilized to a tarsoorbital fascia. Excess periorbital subcutaneous fat is removed within a lower edge of the orbit. Deformed part of tarsoorbital fascia is removed from pretarsal portion of orbicular muscle of eye to lower edge of orbit. Orbitomalar ligament is incised along the whole length and dissected in the caudal direction under the orbicular muscle of eye with crossing the malar ligament and dissecting it in the caudal direction. Caudal sub-periosteal flap is formed, for which, caudally to the lower orbital rim, the periosteum is dissected from the projection of the medial angle of the palpebral fissure to the projection of the lateral angle of the palpebral fissure, with preservation of the infraorbital neurovascular bundle, further, performing the subperiosteal mobilization of soft tissues from the maxillary and zygomatic bones by detachment of the flap, the boundaries of which pass: medially – along the projection of the medial angle of the palpebral fissure; lateral – behind a zygomatico-facial neurovascular bundle at distance of 10 mm; caudally – to the middle of the alveolar process of the upper jaw with further dissection of the periosteum, perpendicular to the dissection plane, and with the formation of a displaced subperiosteal flap; caudal-lateral – under the aponeurosis of the masseter muscle, going beyond the edge of the body of the zygomatic bone. Periosteum is mobilized intraorbitally with preserving the integrity of the intraorbital branch of the zygomatico-facial artery and eliminating injuries of the orbital bottom, thereby forming a cranial periosteal flap. That is followed by three microperforations of the orbital rim at an angle to a bone plane forming the orbital rim. Soft tissues of the mid-face with a caudal subperiosteal flap are moved in the cranial direction with modelling the volume of the zygomatic region and creating a support for the lower eyelid, until the skeletonization of the lower edge of the orbit is eliminated, and fixed with a thread to the lower orbital edge through the previously formed microperforations with U-sutures. Edges of the caudal and cranial periosteal flaps are sutured. Excess skin in area of lower eyelid, formed after dislocation of midface tissues, is excised within part of detachment above pretarsal portion of orbicular muscle of eye. Lateral edge of the mobilized preseptal portion of the orbicular muscle of the eye is fixed within the superficial musculocutaneous flap to the periosteum of the lateral edge of the orbit to restore the natural contour of the lower eyelid.

EFFECT: method allows for the complex minimally invasive rejuvenation of the patient due to the simultaneous etiopathogenetic removal of the masking bags, stabilization of the initial shape of the palpebral fissure, prevention of classical deformations of the lower eyelid specific for classical blepharoplasty with underlying low risk of postoperative deformations of the palpebral fissure in the patients with a complex anatomy of the periorbital zone: postoperative shortening of the lower eyelids, eyelid deformation of the "round eye" type, eversion of the lower eyelids.

1 cl, 1 ex