Preface: Midface and Periocular Rejuvenation xiii

Anthony P. Sclafani

Brow/Upper Lid Anatomy, Aging and Aesthetic Analysis 117

Gregory Branham and John B. Holds

The upper eyelid serves the important anatomic function of protecting the eye and rewetting the cornea to maintain vision. The complex dynamic action of the upper eyelid explains its relatively complex anatomy. The brow has an important supportive role. Studies have revealed facial characteristics perceived as youthful and aged, and the anatomic basis of these changes is defined at many levels. Characteristic aging changes in the upper eyelid and brow create an appearance of aging and opportunities for functional and aesthetic improvement.

Brow/Upper Lid Anatomy, Aging and Aesthetic Analysis 117

Gregory Branham and John B. Holds

The upper eyelid serves the important anatomic function of protecting the eye and rewetting the cornea to maintain vision. The complex dynamic action of the upper eyelid explains its relatively complex anatomy. The brow has an important supportive role. Studies have revealed facial characteristics perceived as youthful and aged, and the anatomic basis of these changes is defined at many levels. Characteristic aging changes in the upper eyelid and brow create an appearance of aging and opportunities for functional and aesthetic improvement.

Midface Anatomy, Aging, and Aesthetic Analysis 129

Andre Yuan Levesque and Jorge I. de la Torre

This article reviews the key anatomic structures in the region of the midface, including important surface and bony landmarks, innervation, blood supply, muscle layers, and fat compartments. It also discusses changes in these structures related to the aging process and aesthetic analysis of the midface to aid with operative planning.

Minimally Invasive Surgical Adjuncts to Upper Blepharoplasty 137

César A. Briceño, Sandy X. Zhang-Nunes, and Guy G. Massry

Video of (1) External Browpexy Procedure, (2) Nasal Fat Preservation, (3) Nasal Fat Preservation: Orbitoglabellar Groove, (4) Lacrimal Gland Repositioning, and (5) Brassiere Suture Fixation of Brow Fat Pad accompanyies this article

A variety of surgical adjuncts can be added to upper eyelid blepharoplasty with the goal of enhancing surgical results and patient satisfaction. All of these procedures are minimally invasive and most are performed through a standard eyelid crease incision. These procedures can be added to stabilize or conservatively lift the outer brow, prevent the stigmata of postoperative volume loss, improve the brow-eyelid transition and contour, and reposition a prolapsed lacrimal gland. The procedures are generally straightforward, easily learned, and complication free. Familiarity with these techniques provides the aesthetic eyelid surgeon with added options to improve surgical results.

Minimally Invasive Options for the Brow and Upper Lid 153

César A. Briceño, Sandy X. Zhang-Nunes, and Guy G. Massry

Eyebrow and upper eyelid aging occurs in all tissue planes, and manifests most commonly in skin quality, tissue volume loss (soft tissue and bone), and tissue descent. All these involutional changes are amenable to less-invasive (nonsurgical) interventions with natural and aesthetically pleasing results. It is critical for aesthetic facial surgeons to familiarize themselves with these procedures because they are in high demand by patients. This article outlines current concepts of nonsurgical management options for brow and upper eyelid aging. The anatomy and age-related changes in these structures are reviewed, and minimally invasive techniques to address these changes are detailed.