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Aging affects all areas of the face for which there s no one single surgical procedure that simultaneously corrects all of them. The most known anti-aging surgery is the facelift, and while tremendously effective at improving the neck and jowls, its effects are more limited north of the lower third of the face. The sagging midface can be addressed at the time of the facelift and a wide variety of techniques have been described to do so.

The submalar hollowing that often occurs with facial aging tissue descent can be treated with either a lift or voluminization techniques. Lifting has been well described but is a more involved procedure. Fat grafting has become more popular of late as part of its overall use as a soft tissue augmentation method,.In addition more recent anatomic studies have identified numerous midface fat compartments and their loss with aging. Interestingly submalar implants as a midface volume method has been available for almost three decades but is rarely mentioned in contemporary facial rejuvenation surgery.

In the April issue of the Aesthetic Surgery Journal an article was published entitled ‘Enhancing Facelift With Simultaneous Submalar Implant Augmentation’. In this paper the authors describe their experience with the submalar implant in facelift surgery over a twenty-five year period in forty-eight (48) patients.They had a satisfaction rate of 96%. Complications consisted of temporary infraorbital nerve numbness (2%), prolonged swelling (1%) and capsular contracture. (1%) No infections or implant removals were required.

It is no surprise that a submalar implant is an effective midface voluminization procedure. But it is also a midfacial lifting procedure as its placement requires release of numerous zygomatic osteocutaneous ligaments. This releases the overlying soft tissues and the implant acts as a spacer to hold the released soft tissues up. It is easy to see that would have a more prolonged effect than injectable fillers and fat injections or even soft tissue lifts.

What is more surprising is that in nearly fifty patients no infections or implant mapositions occurred given that the number of implants placed being close to one hundred. For an intraoral implant procedure, this indicates a high skill level in placing them.

Dr. Barry Eppley

Indianapolis, Indiana

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